Abstract
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.
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Selected References
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- Bronstein J. M., Morrisey M. A. Determinants of rural travel distance for obstetrics care. Med Care. 1990 Sep;28(9):853–865. doi: 10.1097/00005650-199009000-00013. [DOI] [PubMed] [Google Scholar]
- Cohen M. A., Lee H. L. The determinants of spatial distribution of hospital utilization in a region. Med Care. 1985 Jan;23(1):27–38. doi: 10.1097/00005650-198501000-00004. [DOI] [PubMed] [Google Scholar]
- Edwards M., Miller J. D., Schumacher R. Classification of community hospitals by scope of service: four indexes. Health Serv Res. 1972 Winter;7(4):301–313. [PMC free article] [PubMed] [Google Scholar]
- Garnick D. W., Lichtenberg E., Phibbs C. S., Luft H. S., Peltzman D. J., McPhee S. J. The sensitivity of conditional choice models for hospital care to estimation technique. J Health Econ. 1989;8(4):377–397. doi: 10.1016/0167-6296(90)90022-u. [DOI] [PubMed] [Google Scholar]
- Garnick D. W., Luft H. S., Robinson J. C., Tetreault J. Appropriate measures of hospital market areas. Health Serv Res. 1987 Apr;22(1):69–89. [PMC free article] [PubMed] [Google Scholar]
- Hogan C. Patterns of travel for rural individuals hospitalized in New York State: relationships between distance, destination, and case mix. J Rural Health. 1988 Jul;4(2):29–41. doi: 10.1111/j.1748-0361.1988.tb00310.x. [DOI] [PubMed] [Google Scholar]
- Kane R. L. Determination of health care priorities and expectations among rural consumers. Health Serv Res. 1969 Summer;4(2):142–151. [PMC free article] [PubMed] [Google Scholar]
- LEMBCKE P. A. Measuring the quality of medical care through vital statistics based on hospital service areas; I. Comparative study of appendectomy rates. Am J Public Health Nations Health. 1952 Mar;42(3):276–286. doi: 10.2105/ajph.42.3.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Luft H. S., Garnick D. W., Mark D. H., Peltzman D. J., Phibbs C. S., Lichtenberg E., McPhee S. J. Does quality influence choice of hospital? JAMA. 1990 Jun 6;263(21):2899–2906. [PubMed] [Google Scholar]
- Morrisey M. A., Sloan F. A., Valvona J. Defining geographic markets for hospital care. Law Contemp Probl. 1988 Spring;51(2):165–194. [PubMed] [Google Scholar]
- Werden G. J. The limited relevance of patient migration data in market delineation for hospital merger cases. J Health Econ. 1989;8(4):363–376. doi: 10.1016/0167-6296(90)90021-t. [DOI] [PubMed] [Google Scholar]
- Williams A. P., Schwartz W. B., Newhouse J. P., Bennett B. W. How many miles to the doctor? N Engl J Med. 1983 Oct 20;309(16):958–963. doi: 10.1056/NEJM198310203091606. [DOI] [PubMed] [Google Scholar]