CAN MARKET-BASED SOLUTIONS WORK FOR ALL OF MEDICARE - BARRIERS TO REFORM IN THE MEDICARE POPULATION RESIDING IN HEALTH PROFESSIONAL SHORTAGE AREAS

The proportion of the Medicare-eligible population Living in health pr ofessional shortage areas (HPSAs), their demographics, and three healt h status indicators were examined in relationship to market-based refo rm proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,60 2). Chi-squares were computed for demographic variables and health sta tus indicators. A Mantel-Haenszel summary chi-square was computed afte r stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Signifi cant differences in all demographic variables except sex were detected . HPSA residents were more likely to have a mobility limitation, self- care limitation, or both a mobility and self-care Limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be ina dequate to support market-based reforms.