Health Transportation Shortage Index (HTSI): A new measure of child health access

Most discussions of barriers to child healthcare access focus on the availability of insurance. Other factors pose additional barriers, including health professional shortages and inadequate public transportation. In areas with limited health professionals necessitate longer distances to obtain care. Children's Health Fund (CHF) developed a new tool, the Health Professional Shortage Index (HTSI) to identify communities where transportation shortages contribute to difficulty accessing healthcare. The HTSI is based primarily on a nationally representative 2006 survey conducted for CHF that examined transportation resources and healthcare access. These data were supplemented by a 2010 survey of 11 Mississippi Delta counties. The results were validated against demographically similar areas in Texas using Geographic Information System (GIS)-based analysis of hospital discharge data for ambulatory care sensitive condition (ACSC)-related emergency department utilization. With effective primary care, emergency department use and inpatient stays for ACSCs should be unnecessary. The HTSI serves as a guide in assessing important factors associated with transportation barriers to child healthcare access. The HTSI factors are: 1) population, scored by USDA area standards as a proxy for ruralness and travel distance; 2) poverty as a proxy for automobile ownership; 3) health care provider workforce availability (Health Professional Shortage Areas); and 4) public transportation availability. Points are assigned for each factor where higher scores indicate greater risk for transportation barriers to child healthcare access. This new planning tool facilitates the targeting of communities for additional transportation resources and/or improved coordination between the healthcare and transportation sectors to facilitate child health access.