The distance to community medical care and the likelihood of hospitalization: is closer always better?

Abstract

OBJECTIVES: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. METHODS: Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. RESULTS: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. CONCLUSIONS: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.

Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?

“…However, the improved geographic access to primary care services did not result in decreased rates of specialty care and inpatient care, nor did it result in lower costs. These results lend support to four previous studies that found that improved access to primary care does not necessarily reduce inpatient utilization (Ricketts et al 2001;Goodman et al 1997;Weinberger, Oddone, and Henderson 1996;Manning et al 1987). In particular, our results indicate that improving geographic access alone may not be sufficient to shift the locus of care from specialty/inpatient settings to ambulatory primary care settings.…”

Living in a rural area with advanced chronic respiratory illness: a qualitative study

“…Participants in this study demonstrated that 'place', ("This is home to me...") can in fact be more important than 'distance', in choosing to remain in rural settings. 24 Participants' perceptions of higher levels of community support in rural settings have been confirmed in other studies. 25,26 Compared to urban dwellers, rural residents are also more likely to see relatives on a more regular basis, know and trust their neighbours, volunteer, and have a sense of community belonging.…”

“…27 The literature relating to health care of rural residents suggests that there may be a differential perception of need and a reduced expectation for primary care among rural residents compare to urban counterparts. 24 This difference may help to explain participants' acceptance of limited physician availability.…”

Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics

“…1,2,[4][5][6][7][8][9][10][11] Patients covered by either commercial or managed care insurers have higher bypass rates than patients covered by other types of payers. 12 The elderly bypass local care less frequently, 1,2,4,10,11,13,14 and working men do so more frequently. 2,15 Diagnosis and severity of illness are also related to bypass.…”