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Area Health Resource Files (AHRF)

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Dataset Summary

The Area Resource File (ARF) compiles information from more than 50 databases and other sources to provide comprehensive county-level information on a variety of health care utilization, health professions and facilities, environmental, and socio-demographic topics.  The basic file contains a variety of geographic descriptors and codes that enable aggregation of county-level data into geographic groupings and to link to other files.  As a result, it is commonly used as a stand-alone database to evaluate geographic distribution of health services, professions, and facilities, and to provide contextual geographically-based information in combination with other datasets.  

Expert comments 

The greatest strength of the ARF is its breadth - using the ARF is much more efficient than trying to track down data from multiple sources on one’s own. The documentation provided by the vendor is good and the file can be easily merged with any other file that contains standard codes for counties, states, and other geographic areas. Another major strength of the ARF is the level of detail available on the physician workforce. These data are compiled from the AMA Masterfile. They are especially valuable to researchers who are interested in focusing on the workforce in a particular specialty or limiting their analysis to physicians engaged in a particular major professional activity (e.g., patient care). The ARF is a much less expensive alternative to buying AMA Masterfile data if a researcher only needs to analyze the numbers of physicians in counties or larger geographic areas.  

Although the ARF is probably the best resource of its type, it has some important limitations. First, the county is the unit of analysis. This is fine if a researcher wants to analyze data at the level of counties or larger geographic areas or to examine the effect of contextual factors at those levels on individual patients or providers. However, is not very useful if a researcher is interested in analyzing effects on neighborhoods or other smaller geographic areas. The ARF does not contain zip code level data and, thus, cannot be merged with files in which the zip code is the only geographic variable. Second, the years for which data are available differ across variables in the ARF, which limits its usefulness of for longitudinal research. Data on physician variables are available on an annual basis but data on most other health professions and many socio-demographic variables are available on only a decennial basis because they are obtained from the US Census.

Third, AMA Masterfile data on the physician workforce (which is incorporated into ARF) have some major limitations. Researchers who have analyzed data on physicians collected by state licensing boards have found significant discrepancies between the numbers of physicians reported by licensing boards and the AMA. The AMA data may be less accurate than licensing board data because physicians have a stronger incentive to update their licensure records than to fill out AMA surveys. Where available, researchers whose research questions only concern physicians in a particular state should consider using licensing board data instead of the ARF. (States in which licensing boards routinely collect physician workforce data include California, New York, and North Carolina.) In addition, the numbers of physicians in each county are determined based on physicians’ preferred mailing addresses, which are not necessarily their practice addresses. The lack of certainty about practice location can be problematic if a researcher wants to analyze county level data within metropolitan areas in which large numbers of persons commute across county lines to work.

Dataset Details

Dataset owner / manager   

US Department of Health and Human Services - Health Resources and Services Administration

Study and sample characteristics    

The ARF system contains both current and historical data for U.S. counties compiled from a variety of databases including American Medical Association databases, the US Census Bureau, the National Center for Health Statistics, and more.

Major foci   

Data include the following:

Health Care Professions
•    Physicians by detailed specialty and major professional activity, gender
•    Dentists
•    Physician assistants
•    Nurse practitioners
•    Data for other major health professions

Health Professions Training
•    Statistics on medical, pharmacy, dental, and optometry schools and other health professions training schools
•    Schools by county
•    Enrollments
•    Graduate levels

Health Facilities
•    Services
•    Beds by type
•    Hospital personnel
•    HMO enrollments
•    Nursing facilities
•    Ambulatory surgery centers
•    Hospices
•    Home health agencies

Hospital Utilization
•    Admissions
•    Inpatient days
•    Outpatient visits
•    Emergency room visits
•    Discharges
•    Utilization rates
•    Surgical operations

Hospital Expenditures
•    Expenditures
•    Payroll
•    Medicare enrollments and rates

Population and Economic Data
•    Demographics by age, race, sex
•    Employment
•    Income levels
•    Housing statistics
•    Vital statistics
•    Health insurance

•    Population per square mile
•    Land area
Codes and Classifications
•    Metropolitan Statistical Areas
•    ERS typology codes
•    Rural/urban codes
•    Region codes
•    Shortage area designations


Links to other datasets   

ARF data can be linked to other datasets via geographic identifiers

Papers published   

Click here for a PubMed search for articles using this dataset.

Examples of papers published using ARF data include:  
Health care utilization and the proportion of primary care physicians.
Kravet SJ, Shore AD, Miller R, Green GB, Kolodner K, Wright SM.
Am J Med. 2008 Feb;121(2):142-8.
Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.
O'Malley AS, Forrest CB, Feng S, Mandelblatt J.
Arch Intern Med. 2005 Oct 10;165(18):2129-35.
National inventory of hospital trauma centers.
MacKenzie EJ, Hoyt DB, Sacra JC, Jurkovich GJ, Carlini AR, Teitelbaum SD, Teter H Jr.
JAMA. 2003 Mar 26;289(12):1515-22.
Chiropractic health care in health professional shortage areas in the United States.
Smith M, Carber L.
Am J Public Health. 2002 Dec;92(12):2001-9.
Direct graduate medical education payments to teaching hospitals by Medicare: unexplained variation and public policy contradictions.
Fryer GE Jr, Green LA, Dovey S, Phillips RL Jr.
Acad Med. 2001 May;76(5):439-45.

Dataset accessibility and cost   

Data is available for purchase on CD-ROM for $500 for the basic file or $800 for a Microsoft Access version.  Data from prior years is also available for purchase for a similar price structure.

Help Desk   

Quality Resource Systems maintains the ARF system under contract.  For user support, contact them at:
Tel: (703) 352-7393