State policy approaches to address primary care workforce shortages

Background: As health insurance coverage remains central to the national health reform discourse, a primary care workforce shortage remains a significant health care access barrier for millions of Americans. The Health Resources and Services Administration (HRSA) has identified over six thousand primary care Health Professional Shortage Areas (HPSAs) within the United States, requiring 16,585 primary care providers to serve 65 million people. Known contributing factors include provider social, economic and professional practice barriers. Inconsistency of primary care provider access causes patients living in underserved areas to suffer poor and inequitable health outcomes.

Purpose: To identify successful state approaches to policy development and agency collaboration to address primary care workforce shortages.

Methodology: A qualitative, multi-state comparative analysis of enacted and pending state legislation and regulations to address workforce shortages was conducted. Additionally, key informant interviews were conducted with state health agency personnel to identify potential and realized outcomes and successful approaches to policy development and advocacy.

Findings: The findings indicate a variety of state policy approaches to address primary care workforce shortages, including loan repayment programs, rural practice incentives and entities such as task forces to identify further policy solutions. In addition, state health and education agencies as well as universities have engaged in collaborative efforts to advocate policy changes and develop administrative solutions.

Conclusion: States can increase access to primary care by addressing workforce shortages through innovative policy approaches, including successful agency and university collaboration, legislative advocacy, regulatory action and coalition building.