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Abstract

BackgroundAdmissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance) are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates.ResultsWe examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas.ConclusionThe relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly who reside in sprawling urban areas have access impediments about equal to residents of poor rural communities is new, and demonstrates the value of conceptualizing and modelling impedance based on place and local context.

Spatial distribution of tuberculosis from 2002 to 2012 in a midsize city in Brazil

“…Computer-based Geographical Information System (GIS) tools have become especially useful in identifying clusters of areas with the highest incidence of a disease, in assessing the evolution of the spatial distribution of disease with respect to time and in analyzing health care networks [7, 8]. In the present study, we have analyzed the spatial distribution of TB cases in Divinopolis, and investigated the association between density of cases, as defined by spatial analysis, and sociodemographic variables.…”

Environmental factors associated with primary care access among urban older adults

“…utilization). In general, this work has focused on larger area levels, such as counties and metropolitan areas (Andersen, Yu, Wyn, Davidson, Brown, & Teleki, 2002; Basu & Mobley, 2010; Fisher, Wennberg, Stukel, Skinner, Sharp, Freeman et al, 2000; Fortney, Thill, Zhang, Duan, & Rost, 2001; Litaker, Koroukian, & Love, 2005; Mobley, Root, Anselin, Lozano-Gracia, & Koschinsky, 2006; Parchman & Culler, 1999; Shi & Starfield, 2001). Yet, little is known about how variations in the health care environment within borders – especially in dense urban areas – might influence health care access for vulnerable groups (Guagliardo, 2004).…”

“…Yet, little is known about how variations in the health care environment within borders – especially in dense urban areas – might influence health care access for vulnerable groups (Guagliardo, 2004). Although evidence suggests that supply variations cannot fully explain disparities in access (Alexander, Lee, Griffith, Mick, Lin, & Banaszak-Holl, 1999; Gaskin & Hoffman, 2000; Kirby & Kaneda, 2005; Ricketts, Randolph, Howard, Pathman, & Carey, 2001; Shi & Starfield, 2001), it is conceivable that older adults’ ability to access health care may be sensitive to a combination of low availability and travel barriers, as has been found in rural and suburban areas (Fortney, Chumbler, Cody, & Beck, 2002; Mobley et al, 2006). Little is known about how environmental factors influence access to care among urban older adults.…”

Medicare Managed Care plan Performance: A Comparison across Hospitalization Types

“…We assume that these areas are the best approximation of the service areas in which the Medicare beneficiaries travel to receive ambulatory care, and these regions have been validated in previous research on elderly access to preventive care services Basu, J., Mobley, L.R. E5 (Goodman et al, 2003& Mobley, Root, Anselin, Garcia, & Koschinsky, 2006. Since managed care is expected to improve outcomes through better availability of primary and preventive care in the healthcare market, an areal unit that reflects a primary care market is appropriate.…”