Organization and Financing of Indigent Hospital Care in South Florida

By Catherine A. Jackson; Amanda Beatty | Go to book overview

APPENDIX B
PATIENT TRAVEL PATTERN ANALYSIS

We examine the travel patterns of uninsured patients with those of Medicaid and commercially insured persons to determine whether or not geographic access to care is similar across payers.78 In interpreting the results, we pay particular attention to those differences that may reflect the influence of a particular approach to the organization and financing of indigent care in a given county.

Patient hospital choice is a result of numerous factors including convenience, preference, quality, insurance plan, etc. Research has shown that patients tend to be admitted to hospitals that are close to their homes.79 Patients also choose hospitals because of recommendations by friends and family, reputation, or where a particular physician has admitting privileges.80

Among the reasons a patient may select a particular hospital, only two can be addressed in the Florida hospital discharge data: place or residence and insurance. Our analytic approach depends on comparisons of travel patterns between patient groups to see if there are differences that could be attributable to insurance, assuming the other factors determining hospital choice are averaged out. One comparison is between uninsured and Medicaid patients, two typically low-income populations. We assume that the similarity in income reflects similarity in other characteristics, such as education, that may affect patient hospital choice. The second comparison is between uninsured and commercially insured patients, where we assume that those with insurance can obtain care with the greatest degree of choice. Access to care for commercially insured persons is considered in this analysis as the “gold standard.” If access to care for the uninsured is not limited, their travel

____________________
78
While the research focus is broader, the analytic methodology of the analysis seen here is similar to that used in Hospital Care for the Uninsured in Miami-Dade County: Hospital Finance and Patient Travel Patterns, Jackson et al., 2002.
79
Adams et al. (1991), Garnick et al. (1989), Luft et al. (1990), and Phibbs et al. (1993).
80
Burns and Wholey (1992).

-97-

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