Health Resources & Services Administration: Unique Goals For Student Assistance
by Bruce C. Baggett, Director, Division of Student Assistance
Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services

At a time when the U.S. is experiencing its greatest economic prosperity and growth, nearly 45 million Americans find themselves "medically underserved," partly the result of an uneven distribution of health care providers. The time is now for government, public, and private organizations to take action on closing the access gap. Health professions schools are particularly well positioned, through directed missions, to effect major improvement. Recognizing this, Dr. Jordan Cohen, President, Association of American Medical Colleges (AAMC) in his 1999 annual President's message, stated, "If we in academic medicine do not engineer a better health care environment for the country, no one will." Cohen continued, "Our core purpose - improving the public's health - is all but invisible, and most in need of restoring." By saturating the admissions, didactic, and clinical character of the institution with emphasis on accepting and preparing health professionals intending to provide primary care in medically underserved areas, health professions schools could significantly lessen the number of medically underserved Americans. Schools with missions of this character would undeniably foster the restoration of which Dr. Cohen spoke.

However well positioned health professions schools may be to help close the access gap, they are not in this alone. The Health Resources & Services Administration (HRSA), with an annual budget over $4 billion, has as its primary goal: 100% access to health care for all Americans. The HRSA's programs address the health care needs of a wide spectrum of special or underserved populations. The Agency's Bureau of Health Professions (BHPr) focuses on improving and increasing the diversity and distribution of the nation's health care workforce as one strategy toward ensuring access and best meeting the health care needs of the country. In support of this effort, the BHPr (through its Division of Student Assistance - DSA) administers several loan, scholarship, and loan repayment programs, which in 1999 provided over $225 million in assistance to 42,000 health professions students. Eligible students - depending on the specific loan, scholarship or loan repayment program - display financial need and either come from a disadvantaged background or are committed to practicing primary care. Through these programs, the HRSA assists schools in developing a more diverse student body, with greater numbers training in primary care and focusing on ultimately practicing in medically underserved communities. We urge our financial aid administrator partners to help educate deans and other administrators about the potential to close the access gap through ensuring institutional eligibility for the various HRSA student assistance programs.

So why deliver this message to financial aid administrators? Largely to clarify HRSA's goal for monies spent on student assistance. Because the arena is education, it is easy to think of the goal of all student assistance funds as access-to-education. However, unlike the Department of Education's student assistance programs, HRSA's student assistance programs are strongly tied to its access-to-health- care goal. The HRSA believes that increasing the diversity in health professions schools will improve the distribution of health care providers, as students from medically underserved areas and populations are more likely to return to practice in these areas than their counterparts not from underserved areas. In addition, the HRSA believes that through schools dedicating greater emphasis to primary care training there will come significant closure in the access gap. Therefore, we continue to focus our efforts on how to best direct funds toward closing the access gap through promoting diversity and distribution.

More and more, in keeping with the Government Performance and Review Act (GPRA), HRSA must demonstrate to Congress that its programs are meeting the goal of improving access to health care for all Americans, especially underserved groups. In order to articulate achievement to Congress, HRSA must rely on recipients of its funds to demonstrate outcomes.

Because of the need to demonstrate progress made with the money entrusted to it by Congress, and because of the unique goals (i.e., health care workforce development) of HRSA's student financial assistance programs, we will continue to place emphasis on outcome-based measures for school eligibility and for awarding funds. These measures will be tied to developing diversity in health professions schools, and focused on the type and geographic placement of health professions graduates to best meet the health care needs of the country.

It is our hope that with your increased understanding of our programs' intent will come more tolerance for additional burden that may come with participation in our programs, such as Scholarships for Disadvantaged Students (SDS) and Primary Care Loan (PCL). While it may not be easy to produce figures on such things as graduates practicing primary care or in underserved areas, or to make determinations on the disadvantaged backgrounds of students, these are key components to the programs set forth in legislation and entrusted to HRSA. It is through such outcome-based measures that progress toward closing the access gap can best be measured. We at HRSA applaud institutions dedicating themselves to the effort involved in being eligible for participation in our student assistance programs. These are the very institutions making strides toward the purpose in need of restoring that Dr. Cohen spoke of.

It is time for us all to embrace a national ethic that allows for nothing short of 100% access to health care. Health professions schools have the opportunity and responsibility to lead in this effort. For any accepting the challenge, it is hoped that the commitment to training tomorrow's most benevolent and conscientious health care professionals will result in a new form of institutional prestige, gained through refocusing on their fundamental purpose: improving the health of individuals and communities. As financial aid administrators, when the burdens imposed by our programs seem heaviest, remember the larger picture... that through HRSA's student assistance programs, you can not only help needy students, but also make a difference in the lives of people who need health care.