Access to Health Care Services and the Effect on Health Outcomes in a Region: A Spatial Perspective
Year: 2013
Type: article
Abstract: According to the Centers for Medicare and Medicaid Services, national healthcare expenditures reached $2.5 trillion in 2010.Federal, State, and local governments accounted for forty-three percent ($1 trillion) of these expenditures.The question arises as to whether the allocation of health care services in a region or sub-region can be optimized to reduce health care spending and improve health outcomes.A region that has a poor distribution of health care services may find that health outcomes are worse than a region with a good distribution of health care services.However, little research has been conducted to ascertain the effects of these decisions on health outcomes.This study explored how the allocation and amount of health care services affects the health outcome within the region.By better understanding the impact of the amount and distribution of health care services, policy makers will be in a position to better allocate funding for the location and distribution of health care services.This study used a spatial econometric approach coupled with a recently developed measurement, mortality amenable to health care, to answer the research question for the state of Florida.Data was obtained from a number of sources, primarily the Florida Department of Health and the Area Resource File.A gravity model was constructed to measure acute care, hospitals and rural clinics, as the level of spatial accessibility.This gravity model controlled for supply and demand interactions and allowed people to travel large iii distances to receive care.A travel impendence factor controlled for people being less likely to travel past numerous facilities when seeking care.Models were constructed for the entire state, urban areas, and rural areas to determine how the results varied.Age-adjusted overall mortality analyses and sensitivity analyses of gravity model measures were performed.In the overall state analyses, the concentration of primary care physicians and physician assistants were found to be statistically significantly associated with the age-adjusted overall mortality rate for the county.For both explanatory variables an increase in the health care service spatial accessibility was associated with a corresponding decrease in the ageadjusted overall mortality rate for the county.The urban county analyses revealed a positive association for the following health care service explanatory variables: primary care, nurse practitioner, and physician assistants.In the rural models, no explanatory variables were significant.These results suggest that spatial accessibility of health care services in the rural counties of Florida do not have an effect on the mortality amenable to health care rate or age-adjusted overall mortality rate.This study found that health care resources do not meaningfully influence health outcomes as measured by mortality amenable to health care.Similar to other studies, these results suggest that establishing the link between quantity and distribution of health care services to health outcomes (quality) is difficult.Based on these findings, programs aimed at improving spatial accessibility in Florida should be reviewed critically.foresight, guidance, and mentorship.Dr. John A. Rizzo has been a gracious advisor and mentor in the field of public health economics.Our conversations, especially around the methodological issues, have shaped my own worldview tremendously.
Author: Peter J. Mallow
Institution: University of Cincinnati
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2536735212