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

描述（由申请人提供）：美国-墨西哥边境地区是一个重要的和未充分研究的地区，研究在医疗保健的获得，质量和成本的差异。许多美国公民和法律的居民从边境地区进入墨西哥接受医疗和/或药品。由于边境美国一侧的医疗保健服务不足，文化偏好，处方要求较宽松，以及更实惠的提供者选择（1 - 5），过境很常见。自2006年以来，暴力犯罪在墨西哥北方各州迅速上升;这种暴力犯罪很可能会增加为健康而越境的成本 护理和减少在墨西哥寻求护理的可能性。此前没有研究涉及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医疗保健或用美国提供者代替墨西哥医疗保健。我将通过估计在确定一个常规供应商（Aim）方面的变化来间接衡量这些变化中的哪一个正在发生 1）。完全放弃门诊护理可能会导致门诊护理敏感性疾病的住院人数增加（目标2）。未投保者使用急诊室的变化可能是由于美国护理的替代（例如，对于非紧急情况使用艾德）或前述护理（例如，由于护理延迟而向艾德呈现严重状况），这将在目标2中进行研究。如果目标1的分析表明，暴力影响有一个定期提供者的可能性，我将使用工具变量来估计报告定期提供者在县一级的ACS条件率的影响（目标3）。对于目标1和3，我将使用行为风险因素监测系统的个人数据。对于目标2和3，我将使用AHRQ的医疗保健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以及州急诊科数据库来衡量门诊护理敏感条件的入院情况以及急诊科的非紧急和可预防使用。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应对这一持续问题的适当政策非常重要。量化报告定期提供者对门诊护理敏感入院率的影响是一个不仅在边境地区感兴趣的问题，但对于美国医疗保健系统的其他部分也是如此。 公共卫生相关性：墨西哥北方各州犯罪率上升导致的医疗服务获得的快速变化可能会对美国边境地区的医疗服务利用和质量产生影响。对这一影响的估计将有助于制定应对这一持续暴力的政策，以维持或改善边境地区的卫生保健服务和卫生成果。

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.