Understanding Critical Shortage Facilities: Your Hospital's Status

Health Professional Shortage Areas (HPSAs) are geographic areas, populations, or facilities that lack adequate healthcare services, particularly in primary care, mental health, and dental care. HPSA designations are based on criteria established by regulations outlined in the Public Health Service Act. Various tools and maps are available to help individuals determine whether their community or hospital falls within an HPSA. This includes state-specific data and resources provided by entities such as the Colorado Department of Public Health and Environment and the Georgia Department of Community Health.

Characteristics of a Critical Shortage Facility

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Areas with shortages of health professionals

Health professional shortage areas (HPSAs) are designated based on a demonstrated unmet need for provider capacity. The federal scoring method considers population-to-provider ratios and other discipline-specific indicators of need. HPSAs are identified for primary care, mental health, dental health, and substance use disorder health services.

In the United States, maps and data are available to determine whether a community is located in an HPSA. California, for example, has Health Professional Shortage Areas in primary care, mental health, and dental health. Colorado has also designated HPSAs for substance use disorder health services and behavioral health services.

At a global level, health workforce shortages are reported in most countries, with concerns about worsening shortages in the future. These shortages are influenced by challenges in education, employment, deployment, retention, and performance of healthcare workers. Underinvestment in education and training, mismatch between education and employment strategies, and difficulties in deploying health workers to rural, remote, and underserved areas contribute to these shortages. International migration of health workers may further exacerbate workforce shortfalls, particularly in low- and lower-middle-income countries.

To address these challenges, the World Health Organization (WHO) has established initiatives such as the Working for Health Programme and the Global Health Workforce Network. The Working for Health Programme supports data strengthening and country-level responses, while the Global Health Workforce Network aims to foster collaboration and improve health workforce data through the International Platform on Health Worker Mobility and Inter-Agency Data Exchange (IADEx).

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Designation types of Health Professional Shortage Areas (HPSAs)

Health Professional Shortage Areas (HPSAs) are designated areas, populations, or facilities that are experiencing a shortage of primary care, dental, or mental health providers. HPSAs can be categorised into three types: geographic, population, and facility-based.

Geographic HPSAs

Geographic HPSAs are defined as geographic areas with a shortage of healthcare providers for the entire population within that area. These areas may face barriers to accessing care, such as a lack of public transportation, long travel times, or high poverty levels.

Population HPSAs

Population HPSAs refer to specific population groups within a defined geographic area that are facing a shortage of healthcare providers. These groups may include low-income populations, homeless individuals, migrant workers, or other subsets of the population facing economic, cultural, or language barriers to accessing adequate healthcare.

Facility HPSAs

Facility HPSAs are public or non-profit private medical facilities serving a population or geographic area with a shortage of healthcare providers. This includes correctional facilities, youth detention centres, and state mental hospitals with a shortage of psychiatrists. Some facilities are automatically designated as HPSAs based on statutes or regulations.

HPSA designations are important for resource allocation and improving access to primary care, dental, and mental health services. They are also used for the placement of health professionals under certain programs and for establishing health maintenance organisations or community health centres.

HPSA eligibility and scoring

A Health Professional Shortage Area (HPSA) is a geographic area, population, or facility with a shortage of primary care, dental, or mental health care providers. HPSAs are designated by the Bureau of Health Workforce and are used to improve access to essential health services. HPSA eligibility and scoring are based on specific criteria and methodologies.

Eligibility Criteria

To be designated as an HPSA, an area, population, or facility must meet certain eligibility criteria. These criteria include:

• A shortage of primary care, dental, or mental health care providers
• Geographic areas or populations with a lack of access to essential health services
• Specific groups within a defined geographic area, such as low-income populations, homeless populations, or migrant farmworkers
• Public or non-profit private medical facilities serving areas or populations with a shortage of providers
• Federal and state correctional institutions and youth detention facilities with a shortage of mental health providers

Scoring Methodology

The scoring for HPSAs is calculated using the Shortage Designation Management System (SDMS), which utilizes national data sets and supplemental data provided by states and facilities. The scoring methodology varies depending on the discipline, including primary care, dental health, and mental health. However, there are common criteria across all HPSA disciplines:

• Population-to-full-time-equivalent healthcare professional ratio
• Percentage of the population with income at or below a certain percentage of the Federal Poverty Level (FPL)
• Travel distance and time to the nearest source of accessible care

MCTAs and MUAs/MUPs

Maternity Care Health Professional Target Areas (MCTAs) are areas within existing Primary Care HPSAs that face a shortage of maternity healthcare professionals. MCTAs have a separate scoring methodology, with similar criteria to HPSAs.

Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) identify geographic areas and populations with limited access to primary care services. The scoring for MUAs/MUPs depends on the Index of Medical Underservice (IMU), which considers factors such as the provider-to-population ratio, the percentage of the population at the Federal Poverty Level, and the percentage of the population over the age of 65.

Governor-Designated Secretary-Certified Shortage Areas

In addition, Governor-Designated Secretary-Certified Shortage Areas for Rural Health Clinics (RHCs) are identified by state governors or their designees as having a provider shortage. These areas must meet state-developed criteria and are scored separately.

HPSA maps and data

To determine if your hospital is designated as a critical shortage facility, you can utilize the HPSA (Health Professional Shortage Area) maps and data, which identify areas lacking adequate health professional resources. These designations are made by the US Department of Health and Human Services and are based on criteria such as population-to-provider ratios and other factors influencing access to care.

The HPSA designations are categorized into three types:

• Geographic: This designation is assigned to areas with a shortage of primary medical care, dental, or mental health providers across a geographic area, such as a county or a group of counties.
• Population: This designation is for specific populations facing barriers to healthcare access, such as low-income populations, Medicaid-eligible individuals, or residents of public housing.
• Facilities: This category includes hospitals, nursing homes, and other healthcare facilities facing a shortage of primary medical, dental, or mental health professionals.

To find out if your hospital is designated as a critical shortage facility, you can follow these steps:

• Visit the HPSA Find Shortage Areas website: https://data.hrsa.gov/tools/find-shortage-areas. This website provides an interactive map and search functionality to help you locate designated shortage areas.
• Use the search bar on the website to look up your hospital by name or address. You can also browse the map, zooming in on your state and county to locate your hospital.
• Click on your hospital on the map or in the search results. This should provide you with detailed information about the facility, including its HPSA score and designation type.
• Alternatively, you can download the HPSA data directly from the HRSA Data Warehouse at https://data.hrsa.gov/data-downloads/hpsa-data. This option allows you to access the underlying data used to create the maps and perform your analysis or generate custom reports.

By utilizing these resources, you can determine if your hospital is located in a designated critical shortage area, which can provide valuable context for understanding the healthcare needs and challenges in your community. This information is essential for policymakers, healthcare administrators, and individuals interested in advocating for improved healthcare access and resources.

HPSA surveys

The Health Resources and Services Administration (HRSA) is the primary Federal agency responsible for improving access to healthcare services for people who are uninsured, isolated, or medically vulnerable. The HRSA website provides a tool called HPSA Find, which allows users to search for Health Professional Shortage Areas (HPSAs) by state, territory, or county. HPSAs are designated by HRSA as having shortages of primary care, dental care, or mental health providers.

HPSA Find provides information on the type of HPSA (geographic, population, or facility-based), the HPSA score, type, status, rural status, and update date. It also allows users to filter, sort, and export the results. Additionally, users can enter an address to determine if it is located in a shortage area and view details about that area, including whether it is eligible for the CMS Physician Bonus Program.

The HRSA website also offers data downloads for HPSA information, including Excel and CSV files with HPSA designations, scores, and boundaries. These downloads can be used for further analysis and mapping of HPSA data.

The Health Center Patient Survey (HCPS) is another tool used by HRSA to collect data on health center issues. The HCPS is a sample-based survey conducted through one-on-one interviews designed to be nationally representative of the Health Center Program patient population. The most recent HCPS was conducted in 2022, with the previous one in 2014. The survey collects data on a wide range of health center issues, including chronic conditions and preventive measures. The results assist HRSA, health centers, and stakeholders in understanding patient experiences, satisfaction, healthcare needs, and access to care.

Frequently asked questions