Collaborative Research: A Spatial Analysis of the Distribution and Consequences of Health Care Policy Implementation in a Federal System

The federal government works alongside states as well as Federally Qualified Health Centers (FQHCs), private sector entities, and non-profit organizations to implement policies aimed to promote the health and well-being of Americans. By shifting resources from the federal government to the states as well as local organizations, those who are closest to the public can tailor health policy to the needs of its residents. However, there is variation in the types of barriers the public may face in accessing these resources. This is especially true in low-Income rural and urban localities. This collaborative project examines how various factors influence the allocation of public resources by using the case of Title X, a unique program whose resources are allocated in many ways across the 50 U.S. states. The project also assesses the link between efficient and equitable resource allocation and local health outcomes. The project provides insights for policymakers to ensure that the American residents who are most in need of support are able to obtain the resources intended to enhance healthy public outcomes.

Insights and methodological advances from a wide array of disciplines—public policy, geography, city and regional planning, and health policy—contribute to the project's development of a nuanced, accurate measurement of access to specialized healthcare resources to ascertain the extent to which state and local governments allocate federal resources in efficient and equitable ways and examine how public health outcomes respond to various modes of policy implementation. The project incorporates geographic information systems (GIS) and statistical/spatial analysis—specifically the integrated two-step floating catchment area (I2SFCA) method—as well as regression and factor analysis to gain leverage over multiple forms of data (e.g. U.S. Census data, demographic variables of state legislatures, public health measures). These analyses highlight the determinants of equitable access to federally-approved reproductive healthcare resources across United States as well as the consequences for those who live within spaces where high-quality resources are not accessible.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.