Ii rational service areas
1 / 27

II. Rational Service Areas - PowerPoint PPT Presentation

  • Uploaded on

II. Rational Service Areas. --------------------------------------------------. (HPSA - RSAs). II-1. HPSA - Rational Service Areas (HPSA - RSAs). --------------------------------------------------. Objective : Participants will understand:

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'II. Rational Service Areas' - hop

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Ii rational service areas l.jpg
II. Rational Service Areas




Slide2 l.jpg

HPSA - Rational Service Areas




Participants will understand:

1)The characteristics of a health professional shortage area/rational service area

2) The criteria used to determine if a service area is rational.


Slide3 l.jpg

Health Professional Shortage Area (HPSA)


Origin: National Health Service Corps (NHSC)

(Measures the shortage of health professionals in an area)

  • Componentsa) Rational Service Area (RSA)b) Population to Provider Ratioc) Contiguous Area Analysis

  • Disciplinesa) Primary Medical Careb) Dental Health Carec) Mental Health Care

  • Type of Designationsa) Areab) Population Groupc) Facility


Slide4 l.jpg

Types of Rational Service Areas(Applies to all types HPSA and MUA/MUP designations)


  • Medical Service Study Areas (MSSAs) – recognized byHRSA’s Shortage Designation Branch (SDB) as rational services areas

    • Whole County

    • Sub-County

  • Catchment Areas

  • (mental health only)


Rational service areas l.jpg
Rational Service Areas


  • Cannot:

  • 1)  Overlap

  • 2) Have more than one HPSA designation per discipline (e.g., geographic and low-income population)

  • 3) Be smaller than a census tract

  • Exceed travel time between population centers

  • Have interior portions carved out


A mssa definitions l.jpg
A. MSSA Definitions


Adopted by the California Healthcare Workforce Policy Commission on May 15, 2002

  • Each MSSA is composed of one or more complete census tracts.

  • MSSAs will not cross county lines.

  • 3) All population centers within the MSSA are within 30 minutes travel time to the largest population center.


A mssa definitions continued l.jpg
A. MSSA Definitions (Continued)


Urban MSSA:

  • Population range 75,000 to 125,000

  • Reflect recognized community and neighborhood boundaries

  • Similar demographic and socio-economic characteristics

Rural MSSA:

  • Population density of less than 250 persons per square mile

  • No population center exceed 50,000

Frontier MSSA:

  • Population density of less than 11 persons per square mile


Problem mssas address l.jpg
Problem MSSAs Address


California has 58 counties with wide ranging differences in size and population

  • U.S. Census Bureau recognizes whole counties as rural or urban.

  • Rural portions of counties such as San Bernardino, Riverside, Los Angeles, and Butte are declared as urban.

  • California’s cities have wide disparities in income and health status.


Rationale for mssas l.jpg
Rationale for MSSAs


Advantages of sub-county / sub-city areas

  • Better means of determining rural and urban areas in California

  • Better means of determining demographic/socio-economic differences and recognizing health disparities

  • Better means of identifying healthcare access in medically underserved communities


Slide12 l.jpg

Major Uses of MSSAs


  • U.S. Public Health Service recognizes MSSAs as “rational service areas” for purposes of determining Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas/Medically Underserved Population (MUAs/MUPs).

  • MSSAs are a principal component for display of large databases through OSHPD’s Geographic Information System (GIS).

  • MSSAs have the potential for assisting in needs assessment, health planning, and health policy development.


Types of mssa l.jpg
Types of MSSA


  • Whole County MSSA

  • Sub-County MSSA


Whole county l.jpg
Whole County



Sub county l.jpg



Service area travel calculation l.jpg
Service Area Travel Calculation


Primary Health CareInterstate Roads: 25 miles X 1.2 = 30 minutes

Primary Roads (include surface streets): 20 miles X 1.5 = 30 minutes

Secondary Roads (mountainous terrain or unpaved road): 15 miles X 2.0 = 30 minutes

Dental and Mental Health CareInterstate Roads: 30 miles X 1.33 = 40 minutes Primary Roads (include surface streets): 25 miles X 1.6 = 40 minutesSecondary Roads (mountainous terrain or unpaved road) 20 miles X 2.0 = 40 minutes

Mapping Sources Used By SDB: Rand McNally Road Atlas, Maps On Us (www.mapsonus.com)


Mapping sources l.jpg
Mapping Sources


Rand McNally Road Atlas


Rand McNally on-line: www.randmcnally.com


Maps on Us on-line: www.mapsonus.com


Slide18 l.jpg

(Use travel calculation from Pages II-16)

Primary Care

17 miles x 1.5 min = 26 minutes

Dental & Mental

17 miles x 1.6 min = 27 minutes


B mental health catchment area l.jpg
B. Mental Health Catchment Area


Since California does not have mental health catchment areas, MSSAs are used for purposes of designating mental health HPSAs.

Service areas can be:

1)   An MSSA

2) One or more MSSAs combined – travel time between each MSSA must be within 40 minutes and population no more than 475,000

3) Whole county - maximum population no more than 475,000.


Slide21 l.jpg

Before Record Time

  • “Census 1990”:

    - ~5,000 census tracts - 29.7 million population

  • It took 2 years

Rural MSSAs = 213

Urban MSSAs = 274

Total MSSAs = 487



  • “Census 2000”:

    - 7,049 census tracts - 33.8 million population

  • It took 9 months with the GIS Redistricting Tool

Frontier MSSAs = 56

Rural MSSAs = 186

Urban MSSAs = 299

Total MSSAs = 541


Slide22 l.jpg

II-22 Record Time

Mssa reconfiguration step by step l.jpg
MSSA Reconfiguration: Step-by-Step Record Time


1) Organized selected 2000 census data in 1990’s MSSA configuration

2) Examined total population, square miles, income information, and demographic data

3) Noted areas defined as “rural” and as “urban”

  a) The MSSA was “rural” if any census defined place within the MSSA has a population of 50,000 or more

  b) The MSSA was “rural” if the density exceeds 250 person per square mile


Mssa reconfiguration step by step24 l.jpg
MSSA Reconfiguration: Step-by-Step Record Time


  • 4) Determined if there were contiguous census tracts within a defined “urban MSSA” that, if separated from the urban MSSA, would stand alone as a “rural MSSA”. Determined if community stakeholders supported creating a new rural MSSA.

  • 5) Determined the population and area (in square miles) of urban MSSAs within the county.

    • Ascertained whether the urban MSSA was greater than five square miles. If it was not, then one or more adjacent census tracts was added to increase the area to five square miles or greater.


Mssa reconfiguration step by step25 l.jpg
MSSA Reconfiguration: Step-by-Step Record Time


  • If the total population of the urban MSSA exceeded 200,000 it was divided into at least two “urban MSSA subdivisions” that had a population range no less than 75,000 and no more than 125,000.

  • Ascertained that each urban MSSA subdivision was within at least five square miles in area. If not, then one or more adjacent census tracts was added to increase the area to five square miles or greater, even if the resulting population of the urban MSSA exceeded 125,000


Mssa reconfiguration step by step26 l.jpg
MSSA Reconfiguration: Step-by-Step Record Time


7) Once consensus (or substantial agreement) among the stakeholders was reached on MSSA reconfiguration, OSHPD prepared a draft motion for the California Healthcare Workforce Policy Commission (CHMPC), which was circulated among the stakeholders in the county.


Slide27 l.jpg

MSSA Reconfiguration Adoption Process Record Time


  • Changes to the boundaries of MSSAs can only be made through motions adopted by the California Healthcare Workforce Policy Commission (CHMPC).

  • Any such motions will be agenda items of CHMPC and should be accompanied support letters from community officials and stakeholders.