36C10G20R0014-002.xlsx

Intro Introduction:

This spreadsheet contains the Urban/Rural/Highly Rural (URH) summaries by facility and county; they are based on the following Census-based definitions for Urban, Rural, and Highly Rural:

• Urban includes all Urbanized Areas defined as densely developed territories with population of 50,000 or more inhabitants that encompass residential, commercial, and other nonresidential urban land uses; and all census tracts in which 30% or more of the population resides in an Urbanized Area. Due to data limitations for Puerto Rico, Urban includes only Urbanized Areas; not included are the census tracts with 30% or more urban population. The Urbanized Areas data are based on the US Census Bureau 2010 Decennial Census. Criteria used for determining the spatial extent of urbanization are available in the Federal Register, Vol. 76, No. 164 dated August 24, 2011.

• Highly Rural includes sparsely populated areas within counties that have a population density of fewer than 7 people per square mile. For highly rural counties that include one or more urban clusters, defined as densely developed territories that contain at least 2,500 and less than 50,000 people, the sparsely populated portion of the county was classified as highly rural and the urban clusters were classified as rural.

• Rural includes all areas that are not Urban or Highly Rural.

• Insular: For the 2010 Census, the Census Bureau did not idenify urban and rural areas for the Island Areas (American Samoa, Guam, the Commonwearth of the Northern Mariana Islands, and the U.S. Virgin Islands). Because the urban/rural designations do not exist, all Island Areas are coded as 'Insular'.

The summaries were generated using the FY2018 Q4 Enrollment file. Data were summarized by enrollee’s nearest Secondary Care (SC) site, and then by their county of residence. For each SC site/County combination, the following information is reported:

• (Column G) Total number of enrollees who reside in the county,

• (Column H) Number of urban enrollees who live in the county and are nearer to the SC site in Column B than any other SC site,

• (Column I) Number of rural enrollees who live in the county and are nearer to the SC site in Column B than any other SC site, and

• (Column J) Number of highly rural enrollees who live in the county and are nearer to the SC site in Column B than any other SC site.

Approximately 11% of Region 5 enrollees do not have a nearest SC site identified because (1) the enrollee cannot travel to a secondary care site without traveling by boat, plane, or ferry, or (2) the travel time from the enrollee’s residence to the nearest SC site exceeds 450 minutes. Those enrollees are summarized by county of residence; the facility fields for those records are empty.

In some counties, enrollees are split between two or more nearest SC sites. Those counties appear two or more times in the County FIPS and County of Residence columns. For split counties, the number of urban, rural, and highly rural enrollees (Columns H-J) for a single row do not add up to the Total Enrollees Residing in County (Column G). The remaining enrollees who reside in that county are reported in the row(s) for the second (third, . . .) SC site(s). For example, enrollees in Denali County (FIPS = 02068) are split between Station Number 463 (Anchorage VAMC) and no closest facility. The value reported in column G is the sum of all urban, rural, and highly rural enrollees regardless of their closest facility.

Region 5