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而研究不足的地区，用于研究医疗保健获取、质量和成本方面的差异。许多来自边境地区的美国公民和合法居民越境进入墨西哥接受医疗和/或药物治疗。由于美国一侧的医疗保健服务不足、文化偏好、更宽松的处方要求以及更负担得起的提供者选择(1-5)，越境很常见。自2006年以来，墨西哥北部各州的暴力犯罪迅速上升；这种暴力犯罪可能会增加跨越边境获取健康的成本 护理和减少在墨西哥寻求治疗的可能性。此前没有研究表明墨西哥的犯罪对医疗保健越境的影响；尚不清楚美国居民是否会放弃医疗保健，还是会用美国的医疗服务提供者取代墨西哥的医疗保健服务。我将通过评估在确定常规提供商(AIM)方面的变化来间接衡量其中哪些正在发生 1)。完全放弃非卧床护理可能会导致因非卧床护理敏感情况入院的患者增加(目标2)。未参保者使用急诊室的变化可能是由于替代了美国的护理(例如，使用急诊室来表示非紧急情况)或前述护理(例如，由于护理延误而向急诊室提出严重病情)，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了有固定提供者的可能性，我将使用工具变量来估计报告常规提供者对县级急性冠脉综合征发病率的影响(目标3)。对于目标1和目标3，我将使用来自行为风险因素监测系统的个人数据。对于目标2和目标3，我将使用由AHRQ的医疗成本和利用项目维护的出院数据；我将依赖州住院患者数据库以及州急诊部数据库来衡量因门诊敏感情况而入院的人数以及急诊科的非紧急和可预防的使用情况。估计由于墨西哥犯罪率上升而导致的美国医疗保健的变化，对于确定对这一持续存在的问题的适当政策反应非常重要。量化定期报告提供者对门诊敏感住院率的影响是一个不仅在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的医疗保健机会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。对这一影响的估计将有助于形成对这一持续暴力的政策反应，以维持或改善边境地区的保健机会和健康结果。

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.