Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.
Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.
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DOI：
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发表时间：
1991-12
影响因子：
3.4
通讯作者：
E. K. Adams;R. Houchens;G. E. Wright;J. Robbins
中科院分区：
文献类型：
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作者：
E. K. Adams;R. Houchens;G. E. Wright;J. Robbins
先前的研究已经证实，理想的医院属性以及增加的距离或旅行时间对医院选择有影响。这些研究在模型选择方面变得越来越复杂。这项研究增加了现有的文献，估计医院和个人特征对医院选择的影响，使用麦克法登的条件logit模型。在这种类型的分析中，以前没有考虑到一些患者特征。特别是，考虑到患者疾病的复杂性（通过疾病分期测量）对医院选择的影响。这些数据包括1986年在三个重叠的农村市场地区超过12，000医疗保险出院。医院选择集被聚合为七组城市和农村医院。研究结果表明，在其他因素不变的情况下，农村医疗保险受益人倾向于选择服务范围大、有教学活动的医院，而不是服务范围小、无教学活动的医院。距离是医院选择的障碍，特别是对老年医疗保险受益人来说。较复杂的病例往往比不太复杂的病例更倾向于选择较大的城市和农村医院，而不是小型农村医院。
Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individual characteristics on hospital choice, using McFadden's conditional logit model. Some patient characteristics have not previously been accounted for in this type of analysis. In particular, the effect of a patient's complexity of illness (as measured by Disease Staging) on the choice of hospital is taken into account. The data consist of over 12,000 Medicare discharges in three overlapping rural market areas during 1986. The hospital choice set was aggregated into seven groups of urban and rural hospitals. Results indicate that rural Medicare beneficiaries tend to choose hospitals with a large scope of service and with teaching activity over those with a lower scope of service and no teaching activity, holding other factors constant. Distance is a deterrent to hospital choice, especially for older Medicare beneficiaries. The more complex cases tend to choose larger urban and rural hospitals over small rural hospitals more often than less complex cases do.