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A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race|ethnicity

  • Jayasree Basu

    (Agency for Healthcare Research and Quality, Rockville, USA)

  • Bernard Friedman

    (Agency for Healthcare Research and Quality, Rockville, USA)

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    The study analyzes the hospitalization patterns of elderly residents to examine whether the relation between distant travel and severity of illness is uniform across racial|ethnic subgroups. A hypothesis is made that severity thresholds could be higher for minorities than whites. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Health Care Research and Quality for New York residents is used, with a link to the Area Resource File and American Hospital Association's survey files. Logistic models compare the association of distant admission with severity corresponding to each local threshold level, race, and type of hospital admission. The study uses four discrete distance thresholds in contrast to recent work. Also, an examination of severity thresholds for distant travel for different types of admission may clarify different sources of disparities in health care utilization. The findings indicate that minorities are likely to have higher severity thresholds than whites in seeking distant hospital care, although these conclusions depend on the type of condition. The study results imply that if costly elective services were regionalized to get the advantages of high volume for both cost and quality of care, some extra effort at outreach may be desirable to reduce disparities in appropriate care. Published in 2006 by John Wiley & Sons, Ltd.

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    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 16 (2007)
    Issue (Month): 7 ()
    Pages: 687-701

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    Handle: RePEc:wly:hlthec:v:16:y:2007:i:7:p:687-701
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    1. Friedman, Bernard & Pauly, Mark, 1981. "Cost Functions for a Service Firm with Variable Quality and Stochastic Demand: The Case of Hospitals," The Review of Economics and Statistics, MIT Press, vol. 63(4), pages 620-24, November.
    2. Burgess, James F. & Avery DeFiore, Donna, 1994. "The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services," Social Science & Medicine, Elsevier, vol. 39(1), pages 95-104, July.
    3. Jayasree Basu & Bernard Friedman, 2001. "Preventable illness and out-of-area travel of children in New York counties," Health Economics, John Wiley & Sons, Ltd., vol. 10(1), pages 67-78.
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