Frontier America's Health System Challenges and Population Health Outcomes

Objective: The objective of this cross-sectional descriptive study was to examine and compare the county level characteristics including demographics, health system factors and population health outcomes of frontier and non-frontier counties in the United States. All counties in the United States were studied using the Community Health Status Indicators (CHSI) 2008 data and the Area Resource File 2008 data. The definition of frontier used in the study is the conventional definition of less than 7 persons per square mile. In 2005, of a total of 3141 counties in the US, 419 were frontier counties. Principal Findings: Frontier counties have a significantly higher proportion of elderly and white population. Although not statistically significant, frontier counties also have a higher poverty rate. Frontier counties have a lower average life expectancy as compared to non-frontier counties. Frontier counties also have a significant lower rate of primary care physician and dentists (although not statistically significant). Conclusions: Empirical literature on the population health outcomes and health system factors of frontier areas is limited. This study describes the unique challenges that frontier counties face in terms of population health outcomes and health system capacity. Implications for Policy, Delivery or Practice: Frontier communities in the US face significant challenges in terms of having populations with higher need for primary care such as the elderly and poor. In addition they have lower supply of health care professionals and have poorer health outcomes. Policy makers should take in to account these factors while designing solutions to the access issues that these populations face.