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Rural residents' demand for hospital services: An empirical analysis of patient outmigration and geographic accessibility.

机译：农村居民对医院服务的需求：对患者外流和地理可及性的实证分析。

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摘要

The rapidly changing health care marketplace poses dramatic challenges for rural communities and the local provision of hospital services. Patient outmigration to urban areas for care represents one such challenge for rural hospitals. Issues of geographic access to hospital services also arise, particularly in rural areas affected by hospital closures, mergers and consolidations. However, despite the importance of these issues, little empirical economic research concerning these issues exists.;This research concerns two aspects of rural residents' demand for hospital services. First, what role do economic variables play in the outmigration of rural residents for hospital services? Is the outmigration of rural residents for hospital care explained simply by the severity of illness and the extent of services provided in the local community? Or, do differences in access to alternative hospitals, in the form of income, insurance holdings, travel costs, and hospital attributes affect the choice of hospital by rural residents? Second, is the utilization of hospital services significantly influenced by differences in geographic access?;To answer these questions, this study develops a combined count/discrete choice model of the rural resident's demand for hospital services. The count portion of the model estimates the annual frequency of inpatient hospitalizations for the sample of rural residents. The discrete choice portion of the model estimates the probability that, conditional upon the use of inpatient hospital services, a rural resident will choose a particular hospital. Using a time-price model of the demand for hospital services, with empirical observations on the decisions of rural residents to travel to alternate hospitals, we infer the value of hospital services delivered in a rural community.;The analysis shows that along with travel cost, age, illness severity, and hospital attributes, income plays a significant role in explaining the observed hospital choices of rural residents. Wealthier residents outmigrate with greater probability, after controlling for illness complexity, age, sex, travel cost, and hospital facility attributes, than do poorer residents. With respect to the demand for a number of inpatient hospitalizations in a year, the analysis reveals that declines in geographic access do not necessarily lead to lower levels of utilization.
机译：快速变化的医疗市场对农村社区和当地提供医院服务构成了巨大挑战。对于农村医院来说，将病人移至城市地区进行护理代表了这样一种挑战。还出现了在地理上获得医院服务的问题，尤其是在受医院关闭，合并和合并影响的农村地区。然而，尽管这些问题很重要，但很少有关于这些问题的实证经济学研究。该研究涉及农村居民对医院服务需求的两个方面。首先，经济变量在农村居民外出务工中起什么作用？是否仅通过疾病的严重程度和当地社区提供的服务程度来解释农村居民外出就医的原因？还是在收入，保险资产，差旅费用和医院属性等形式上替代医院的选择是否会影响农村居民对医院的选择？其次，医院服务的利用是否受到地理条件差异的显着影响？；为回答这些问题，本研究针对农村居民对医院服务的需求建立了一种结合计数/离散选择模型。该模型的计数部分估计了农村居民样本的每年住院住院的频率。该模型的离散选择部分估计了根据住院医院服务的使用情况，农村居民选择特定医院的可能性。使用对医院服务需求的时间价格模型，结合对农村居民前往替代医院的决定的实证观察，我们推断出在农村社区中提供的医院服务的价值。 ，年龄，疾病严重程度和医院属性，收入在解释观察到的农村居民选择医院方面起着重要作用。在控制了疾病的复杂性，年龄，性别，旅行费用和医院设施属性之后，富裕的居民比贫穷的居民更有可能移民。关于一年中许多住院病人的需求，分析表明，地理获取的下降并不一定导致利用率下降。

著录项

  • 作者

    McNamara, Paul Edward.;

  • 作者单位

    University of Minnesota.;

  • 授予单位 University of Minnesota.;
  • 学科 Economics General.;Economics Agricultural.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 1998
  • 页码 198 p.
  • 总页数 198
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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