1. Survey on Rural Community Wealth and Health Care Provision John Pender USDA Economic Research Service (ERS) NCRCRD Webinar November 16, 2011

2. Background and Rationale Access to health care services is limited in many rural areas Health care services are increasingly important to quality of life and economic development of rural areas Although a substantial literature exists on factors affecting physicians’ decisions to locate and remain in rural areas, little research investigates how rural communities and their assets affect recruitment & retention of providers (not just physicians) ERS is planning a telephone survey of rural community wealth and health care provision to be conducted during 2012; follow up field work in 2013 ERS is working with Iowa State University’s Center for Statistics and Survey Methodology and Survey and Behavioral Research Services Group to implement the survey

3. Objectives To improve understanding about – How the assets and investments of rural communities affect recruitment and retention of health care providers – The effects of rural health care provision on economic development in rural communities

4. Study Approach Telephone survey of health care providers and community leaders in 150 towns in three regions: – Lower Mississippi Delta (LMD - AR, LA, MS) – Southern Great Plains (SGP – KS, OK, TX) – Upper Midwest (UMW - IA, MN, WI) Regions selected to include – Areas of limited health care access (esp. LMD and SGP) as well as a contrasting region (UMW) – Variations in community characteristics & assets (poverty, race, ethnicity, social capital, etc.) – Areas where growth in employment in health services is rapid and an important share of the economy More in-depth field interviews be conducted in up to 40 of the surveyed towns during 2013

5. Sample Selection Zip Code Tabulation Areas (ZCTAs) will be used as the primary sampling unit (aggregated to correspond to towns where more than one ZCTA per town) Universe restricted to towns – With population at least 2,500 and less than 20,000 – Without high commuting dependence on large urban areas (<30% dependence) This universe includes about 6.1 million people in 809 towns in the nine study states Strata: – Three regions (LMD, SGP, UMW) – Towns with/without a hospital (about 50% of each) The sample will be allocated among the strata based upon the population of towns and number of physicians per person

6. Respondents Respondents will include – Health care providers - physicians, dentists, nurse practitioners and physicians assistants, hospital and clinic administrators – Community leaders & other stakeholders involved in recruiting and retaining providers – e.g., mayor, public health agency, economic development agency, Chamber of Commerce, other groups Potential respondents will be identified through web searches, phone directories, key informants Respondents will be sampled from the list of potential respondents (up to 15 per town)

7. Questionnaires Two questionnaires: – Health care providers – Community leaders/other stakeholders Target length – 20 minutes average, 30 max Common sections in both questionnaires – Community assets – Health care in your town (access, quality, changes in past 10 years) – Demographic info on respondent (age, gender, ethnicity, etc.)

8. Providers’ Questionnaire Screening questions Provider’s background Current practice Factors affecting decision to work in this town Most important factors affecting recruitment and retention of providers in this town Changes in practice in past ten years and reasons Satisfaction with working in this town Involvement/integration in community Plans to retire or change practice in next five years

9. Stakeholders’ Questionnaire Screening questions Assessment of overall quality of providers Success of town in recruiting, integrating and retaining providers Most recent recruitment effort – For what type of provider – Who involved in recruitment – Success of recruitment – Is provider still working in this town – Reasons for success or failure of recruitment, retention Departures of providers in past ten years, reasons Plans to recruit providers in next five years Most important factors affecting recruitment and retention of providers