Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services
Article first published online: 21 FEB 2003
Health Services Research
Volume 38, Issue 1p1, pages 287–309, February 2003
How to Cite
Goodman, D. C., Mick, S. S., Bott, D., Stukel, T., Chang, C.-h., Marth, N., Poage, J. and Carretta, H. J. (2003), Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services. Health Services Research, 38: 287–309. doi: 10.1111/1475-6773.00116
- Issue published online: 4 DEC 2003
- Article first published online: 21 FEB 2003
- Primary health care;
- small-area analysis;
- health services accessibility;
Objective. To develop and characterize utilization-based service areas for the United States which reflect the travel of Medicare beneficiaries to primary care clinicians.
Data Source/Study Setting. The 1996–1997 Part B and 1996 Outpatient File primary care claims for fee-for-service Medicare beneficiaries aged 65 and older. The 1995 Medicaid claims from six states (1995) and commercial claims from Blue Cross Blue Shield of Michigan (1996).
Study Design. A patient origin study was conducted to assign 1999 U.S. zip codes to Primary Care Service Areas on the basis of the plurality of beneficiaries' preference for primary care clinicians. Adjustments were made to establish geographic contiguity and minimum population and service localization. Generality of areas to younger populations was tested with Medicaid and commercial claims.
Data Collection/Extraction Methods. Part B primary care claims were selected on the basis of provider specialty, place of service, and CPT code. Selection of Outpatient File claims used provider number, type of facility/service, and revenue center codes.
Principal Findings. The study delineated 6,102 Primary Care Service Areas with a median population of 17,276 (range 1,005–1,253,240). Overall, 63 percent of the Medicare beneficiaries sought the plurality of their primary care from within area clinicians. Service localization compared to Medicaid (six states) and commercial primary care utilization (Michigan) was comparable but not identical.
Conclusions. Primary Care Service Areas are a new tool for the measurement of primary care resources, utilization, and associated outcomes. Policymakers at all jurisdictional levels as well as researchers will have a standardized system of geographical units through which to assess access to, supply, use, organization, and financing of primary care services.