Hospital choice of Medicare beneficiaries in a rural market: why not the closest?
Hospital choice of Medicare beneficiaries in a rural market: why not the closest?
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DOI：
10.1111/j.1748-0361.1991.tb00715.x
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发表时间：
1991-01-01
期刊：
影响因子：
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通讯作者：
Wright, G E
中科院分区：
文献类型：
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作者：
Adams, E K;Wright, G E
作为一项更大规模的医院选择研究的一部分，对居住在三个重叠农村地区的12,000多名医疗保险受益人的旅行模式进行了调查。1986年期间，这些医疗保险受益人住进了包括明尼苏达州、北达科他州和南达科他州部分地区的53家医院中的一家。利用居住地邮政编码、就近医院、入院医院等信息，分析了居住在该地区的农村老年医保患者的医院选择。为了总结他们的出行模式，入院医院根据是城市还是农村、规模以及是否是最近的设施进行了分类。调查结果表明，60%的农村医疗保险受益人在离他们最近的农村医院接受医院服务，无论医院规模大小。然而，在最近的医院大于75张床位的人中，79%的人使用了它，而在最近的农村医院小于75张床位的人中，只有54%的人在那里获得了服务。总体而言，居住在这个农村市场地区的30%的人去了城市医院。这些模式似乎反映了医生和/或个人对当地医院相对于其他可用选择的吸引力的评估，以及个人的特点。旅行模式因受益人的年龄及其疾病的相对复杂程度而异，这是通过疾病分期方法来衡量的。调查结果对农村地区医院服务的提供和筹资具有影响。
As part of a larger study of hospital choice, the travel patterns of more than 12,000 Medicare beneficiaries residing in three overlapping rural areas were examined. During 1986 these Medicare beneficiaries were admitted to one of 53 hospitals in an area that encompassed parts of Minnesota, North Dakota, and South Dakota. Information on ZIP code of residence, closest hospital, and hospital of admission were used to analyze hospital choices of the Medicare rural elderly residing in this area. To summarize their travel patterns, the admitting hospital was categorized based on whether it was urban or rural, its size and whether or not it was the closest facility. Findings indicated that 60 percent of these rural Medicare beneficiaries used hospital services at their closest rural hospital, regardless of its size. However, 79 percent of those whose closest hospital was larger than 75 beds used it, while only 54 percent of those whose closest rural hospital was fewer than 75 beds obtained services there. Overall, 30 percent of those residing in this rural market area went to an urban hospital. These patterns appeared to reflect an evaluation by the physician and/or individual of the relative attractiveness of the local hospital versus alternatives available, as well as the individual's characteristics. Travel patterns varied by the beneficiary's age as well as his or her relative complexity of illness, as measured by a Disease Staging methodology. Findings have implications for the provision and financing of hospital services in rural areas.