“After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density”, Justin H. Markowski, Jacob Wallace, Chima D. Ndumele2023-11 (economics)⁠:

Since 1965, the US federal government has incentivized physicians to practice in high-need areas of the country through the designation of Health Professional Shortage Areas (HPSAs). Despite its being in place for more than half a century and directing more than a billion dollars annually, there is limited evidence of the HPSA program’s effectiveness at reducing geographic disparities in access to care and health outcomes.

Using a generalized difference-in-differences design with matching, we found:

no statistically-significant changes in mortality or physician density 1970^–₄₈2018 after a county-level HPSA designation. As a result, we found that 73% of counties designated as HPSAs remained physician shortage areas for at least 10 years after their inclusion in the program.

Fundamental improvements to the program’s design and incentive structure may be necessary for it to achieve its intended results.