Development of a Development of a Rural Typology GI S for Rural - PowerPoint PPT Presentation

Development of a Development of a Rural Typology GI S for Rural Typology GI S for Policy Makers Policy Makers Michael Shambaugh- -Miller, Ph.D. Miller, Ph.D. Michael Shambaugh RUPRI Center for Rural Health Policy Analysis RUPRI Center for Rural Health Policy Analysis College of Public Health College of Public Health University of Nebraska Medical Center University of Nebraska Medical Center th Quadrennial Conference of 6 th Quadrennial Conference of 6 British – – Canadian Canadian – – American Rural Geographers American Rural Geographers British July 15 – – 20, 2007 20, 2007 July 15 Spokane, WA Spokane, WA

The Current Problem The Current Problem � There is no single, universally preferred There is no single, universally preferred � definition of rural that serves all policy definition of rural that serves all policy purposes. purposes. – More than 15 definitions of rural are currently used More than 15 definitions of rural are currently used – by federal health programs. by federal health programs. – There are over 50 definitions of rural for all federal There are over 50 definitions of rural for all federal – programs. programs. – 30 million Census Bureau 30 million Census Bureau- -defined rural people live defined rural people live – in OMB- -defined metropolitan areas. defined metropolitan areas. in OMB – 20 million Census Bureau 20 million Census Bureau- -defined urban people live defined urban people live – in OMB- -defined nonmetropolitan areas. defined nonmetropolitan areas. in OMB

The Policy Considerations The Policy Considerations � The choice of rural definition affects who The choice of rural definition affects who � benefits from a policy and who does not. benefits from a policy and who does not. � Key considerations for understanding the � Key considerations for understanding the policy implications of different rural policy implications of different rural definitions include the following: definitions include the following:

The Policy Considerations The Policy Considerations � Rural definitions can be built on different units of � Rural definitions can be built on different units of geography, each of which has distinct geography, each of which has distinct advantages and disadvantages. advantages and disadvantages. � The two most commonly used classification The two most commonly used classification � systems, those of the Census Bureau and the systems, those of the Census Bureau and the Office of Management and Budget, result in very Office of Management and Budget, result in very different sets of places defined as rural. different sets of places defined as rural. � Policies and programs can be targeted when Policies and programs can be targeted when � rural definitions are combined with key rural definitions are combined with key demographic, economic, or health care provider demographic, economic, or health care provider characteristics. characteristics.

The Policy Considerations The Policy Considerations � Rural designations can change with shifts � Rural designations can change with shifts in population distribution or commuting in population distribution or commuting patterns, or as a result of changes in patterns, or as a result of changes in geographic boundaries. geographic boundaries. � Data availability is essential to support the � Data availability is essential to support the application of the rural definition. application of the rural definition. � There are many resources that can help � There are many resources that can help with understanding the complexities of with understanding the complexities of rural definitions. rural definitions.

What are the potential unintended consequences of What are the potential unintended consequences of relying on commonly used, easily understood relying on commonly used, easily understood definitions, such as those for nonmetropolitan definitions, such as those for nonmetropolitan counties? counties? � Differences between definitions, such as � Differences between definitions, such as those of OMB and Census Bureau, must be those of OMB and Census Bureau, must be clearly understood to anticipate potential clearly understood to anticipate potential unintended consequences. unintended consequences. � OMB � OMB’ ’s definition of counties as metropolitan s definition of counties as metropolitan or nonmetropolitan is often used as a proxy or nonmetropolitan is often used as a proxy for urban and rural. for urban and rural.

Should the selected rural definition be Should the selected rural definition be narrowly targeted or widely inclusive? narrowly targeted or widely inclusive? � While targeted, narrowly � While targeted, narrowly- -defined definitions defined definitions can direct resources to specific populations, can direct resources to specific populations, they also have the potential consequence of they also have the potential consequence of eliminating from policy or program eligibility eliminating from policy or program eligibility places or providers that should be covered. places or providers that should be covered. Conversely, more broadly defined definitions Conversely, more broadly defined definitions might result in the inclusion of areas with might result in the inclusion of areas with less need, with possible budgetary less need, with possible budgetary consequences. consequences.

What Can the Impact of What Can the Impact of a Definition Be? a Definition Be? � � A recent example is the use of the TRICARE definition of rural f A recent example is the use of the TRICARE definition of rural for applying or applying access standards for Medicare Part D. access standards for Medicare Part D. � Policy makers sought a broad, inclusive rural definition in hopes of ensuring s of ensuring � Policy makers sought a broad, inclusive rural definition in hope Part D pharmacist availability across wide areas of rural Americ Part D pharmacist availability across wide areas of rural America. a. � � The TRICARE definition defined rural so broadly that only central cities were l cities were The TRICARE definition defined rural so broadly that only centra excluded from the rural definition. excluded from the rural definition. � Policy makers then mandated that pharmacies be available within 15 miles 15 miles � Policy makers then mandated that pharmacies be available within of 70% of the TRICARE- -defined rural population. defined rural population. of 70% of the TRICARE � � By including areas most people would consider suburban in the rural By including areas most people would consider suburban in the ru ral category, the residual 30% of the TRICARE- -defined rural population not defined rural population not category, the residual 30% of the TRICARE protected by the access standards is a number equal to the entire rural e rural protected by the access standards is a number equal to the entir population under the most population under the most- -used definition. used definition.

Figure 1: Rural Areas as Defined by the TRICARE Retail Pharmacy Program Note: Alaska and Hawaii not to scale Classifications by Person per Square Mile (ppsm) Classifications by Person per Square Mile (ppsm) Rural - less than 1,000 ppsm Suburban - 1,000 to 2,999 ppsm Source: ZIP Code population classifications from #MDA906-03-R-0002, DoD, 2003. Population data from U.S. Census, 2000. Urban - more than 3,000 pppsm ZIP code spatial files based on U.S. Census ZIP Code Tabulation Areas, 2000. Cartogrraphy: RUPRI Center for Rural Health Policy Analysis, 2004.

Most Common Definitions Most Common Definitions � � The most commonly used definitions of rural are based on either The most commonly used definitions of rural are based on either the Census Bureau Urbanized Area categorization of census blocks the Census Bureau Urbanized Area categorization of census blocks and block groups or the Office of Management and Budget (OMB) and block groups or the Office of Management and Budget (OMB) characterization of counties. characterization of counties. � � The Census Bureau intentionally creates a definition of rural by The Census Bureau intentionally creates a definition of rural by designating census blocks and block groups as urban based on total al designating census blocks and block groups as urban based on tot population and population density, with all other areas being rural. ral. population and population density, with all other areas being ru � � The OMB classifies counties as metropolitan metropolitan , when one or more , when one or more The OMB classifies counties as county is the “ county is the “core core” ” and other counties are included based on and other counties are included based on commuting patterns into the core. commuting patterns into the core. � � The OMB metropolitan metropolitan classification was not designed to create a classification was not designed to create a The OMB definition of rural. However, many federal programs use the definition of rural. However, many federal programs use the metropolitan designation to declare all other counties rural. metropolitan designation to declare all other counties rural.