The Disparate Effects of Space and Place on the Health of Medicare Patient Populations

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 14. Healthcare Inequality

Abstract

Domestic medical travelers (DMT) self-refer to high-performing hospitals and have the financial means and quality of health to travel there. These differences are associated with better clinical outcomes and may not be captured appropriately in claims data, which may confer an advantage in risk adjustment to the hospitals they visit.
However, not all non-local patients are DMTs. People may also visit hospitals outside their residential area because of medical emergencies that occur when they are on vacation. Furthermore, not all DMTs may be healthier than their local counterparts if they have complicated cases that require specialists who are unavailable locally.
In this study, we sought to explore the impact of restricting the population used for hospital performance estimation to local patients. Measuring a hospital’s quality based on the outcomes of healthcare delivered to the local market should be more equitable and accurate. It ensures that hospitals are compared based on their ability to serve their immediate communities, rather than their capacity to attract potentially healthier out-of-area patients. Furthermore, measuring hospital quality in this way can provide clues to the environmental, political, and contextual characteristics that influence hospital performance measures.

Authors

• Jamilah A. Watson, University of Delaware

• Bradley G. Hammill, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC