Hospital Care for the Uninsured in Miami-Dade County: Hospital Finance and Patient Travel Patterns

By Catherine A. Jackson; Kathryn Pitkin Derose et al. | Go to book overview
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Chapter Four
GEOGRAPHIC ACCESS TO CARE

To assess whether the organization and financing of indigent care in Miami-Dade was associated with the locations at which uninsured patients received treatment, we performed an analysis of access to hospital care based on how far patients traveled to get such care. Our objective was to determine whether or not uninsured patients had geographic access to hospital care similar to that of their insured neighbors.

Geographic access is only one dimension of access to care, but it is a potentially important one. Patients who travel great distances may not receive care in a timely manner. Moreover, those who are hospitalized far from their homes may experience transportation difficulties and reduced family support. Indeed, research has shown that patients generally tend to be admitted to hospitals that are close to their homes.1 Of course, patients go to particular hospitals for a number of different reasons—for example, they may go to a hospital recommended by friends and family or to a hospital where their doctor has admitting privileges.2 Travel patterns reflect individual preferences and therefore, to some degree, personal choice. But our principal concern is the issue of whether differential geographic access reflects disparities in the health-care system. This focus requires that other factors be netted out in our comparison of insured and uninsured patients. If the uninsured had unlimited access to care,

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1
Adams, Houchens, Wright, and Robbins, (1991); Garnick, Lichtenberg, Phibbs, et al. (1989); Luft, Garnick, Mark, et al. (1990); and Phibbs, Mark, Luft, et al. (1993).
2
Burns and Wholey (1992).

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