Changes in Health Care Access and Utilization in the US-Mexico Border Region

美墨边境地区医疗保健获取和利用的变化

• 批准号: 8262074
• 负责人: Kimberley Lynn H Geissler
• 金额: $ 4.27万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2012-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8262074
• 关键词: Changes; Health; Care; Access; Utilization

DESCRIPTION (provided by applicant): The US-Mexico border region is an important and understudied area for research on disparities in health care access, quality, and cost. Many US citizens and legal residents from the border region cross into Mexico for medical treatment and/or pharmaceuticals. Border crossing is common due to inadequate health care services on the US side of the border, cultural preferences, looser prescription requirements, and more affordable provider options (1-5). Since 2006, violent crime has risen rapidly in the northern Mexican states; this violent crime is likely to increase the cost of crossing the border for health care and decrease the likelihood of seeking care in Mexico. No prior studies have addressed the impact of crime in Mexico on border crossing for health care; it is not known whether US residents will forego care or will substitute Mexican care with US providers. I will measure indirectly which of these is occurring by estimating changes in identifying a regular provider (Aim 1). Foregoing ambulatory care altogether may lead to increases in inpatient admissions for ambulatory care sensitive conditions (Aim 2). A change in utilization of emergency departments by the uninsured may be due to either substitution of US care (e.g., using the ED for non-emergent conditions) or foregoing care (e.g., presenting to the ED with a serious condition because of delay to care), which will be studied in Aim 2. If the analysis for Aim 1 shows that violence affects the likelihood of having a regular provider, I will use instrumental variables to estimate the effect of reporting a regular provider on rates of ACS conditions at the county level (Aim 3). For Aims 1 and 3, I will use individual data from the Behavioral Risk Factor Surveillance System. For Aims 2 and 3, I will use discharge data maintained by AHRQ's Healthcare Cost and Utilization Project; I will rely on State Inpatient Databases as well as State Emergency Department Databases to measure admissions for ambulatory care sensitive conditions as well as non-urgent and preventable use of the emergency department. Estimating changes in US health care as a result of rising crime in Mexico is important to determine appropriate policy responses to this ongoing problem. Quantifying the effect of reporting a regular provider on rates of ambulatory care sensitive admissions is a question that is of interest not only in the border region, but for the rest of the US health care system as well. PUBLIC HEALTH RELEVANCE: Rapid changes in health care access caused by increased crime in northern Mexican states will likely have an impact on health care utilization and quality in the US border region. Estimates of this effect will help shape policy responses to this ongoing violence to maintain or improve health care access and health outcomes in the border region.

描述（由申请人提供）：美国和墨西哥边境地区是研究医疗保健可及性、质量和成本差异的一个重要且尚未得到充分研究的地区。许多来自边境地区的美国公民和合法居民进入墨西哥接受医疗和/或药品。由于美国边境一侧的医疗保健服务不足、文化偏好、较宽松的处方要求以及更实惠的提供者选择，边境跨境很常见 (1-5)。 2006年以来，墨西哥北部各州暴力犯罪迅速上升；这种暴力犯罪可能会增加跨境医疗的成本 护理并降低在墨西哥寻求护理的可能性。先前没有研究探讨过墨西哥犯罪对过境医疗保健的影响；目前尚不清楚美国居民是否会放弃护理或用美国提供者替代墨西哥护理。我将通过估计确定常规提供者的变化来间接衡量正在发生哪些情况（目标 1）。完全放弃门诊护理可能会导致因门诊护理敏感病症住院的人数增加（目标 2）。未参保者对急诊科的使用发生变化可能是由于美国护理的替代（例如，使用急诊室处理非紧急情况）或放弃护理（例如，由于延误护理而向急诊室就诊，病情严重），这将在目标 2 中进行研究。如果目标 1 的分析表明暴力会影响获得常规医疗服务提供者的可能性，我将使用工具变量来估计报告的效果 县级 ACS 状况费率的定期提供者（目标 3）。对于目标 1 和 3，我将使用行为风险因素监测系统中的个人数据。对于目标 2 和 3，我将使用 AHRQ 医疗成本和利用项目维护的出院数据；我将依靠州住院患者数据库和州急诊科数据库来衡量门诊护理敏感情况的入院情况以及非紧急和可预防的急诊科使用情况。估计墨西哥犯罪率上升导致的美国医疗保健变化对于确定针对这一持续问题的适当政策应对措施非常重要。量化报告常规医疗服务提供者对门诊护理敏感入院率的影响不仅是边境地区感兴趣的问题，也是美国医疗保健系统其他部分感兴趣的问题。 公共卫生相关性：墨西哥北部各州犯罪率上升导致医疗保健获取的快速变化可能会对美国边境地区的医疗保健利用和质量产生影响。对这种影响的估计将有助于制定针对这种持续暴力的政策应对措施，以维持或改善边境地区的医疗保健服务和健康结果。

项目成果

The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.

墨西哥北部的暴力事件与美墨边境地区可能可以避免的住院治疗之间的关系。

• DOI: 10.1093/pubmed/fdv012
• 发表时间: 2016
• 期刊: Journal of public health (Oxford, England)
• 作者: Geissler,Kimberley;Stearns,SallyC;Becker,Charles;Thirumurthy,Harsha;Holmes,GeorgeM
• 通讯作者: Holmes,GeorgeM

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents.

探索墨西哥北部凶杀案协会和美国居民的医疗保健服务。

• DOI: 10.1007/s10903-014-0053-4
• 发表时间: 2015
• 期刊: Journal of immigrant and minority health
• 影响因子: 1.9
• 作者: Geissler,KimberleyH;Becker,Charles;Stearns,SallyC;Thirumurthy,Harsha;Holmes,GeorgeM
• 通讯作者: Holmes,GeorgeM

Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?

美墨边境地区的急诊室使用情况与墨西哥的暴力事件：有关系吗？

• DOI: 10.1111/jrh.12109
• 发表时间: 2015
• 期刊: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
• 作者: Geissler,KimberleyH;Holmes,GeorgeM
• 通讯作者: Holmes,GeorgeM