The Effect of Insurance Status on Travel Time for Rural Medicare Patients

Predictors of hospital bypass for rural residents seeking common elective surgery

BACKGROUND

Surgical bypass occurs when rural residents receive surgical care at a nonlocal hospital. Given limited knowledge of current bypass rates, we evaluated rates and predictors of bypass for common procedures.

METHODS

We used 2014 to 2016 all-payer claims data from the Healthcare Cost and Utilization Project State Inpatient Databases to study rural patients from 13 states who underwent 1 of 11 common elective surgical procedures. Bypass was measured by whether a patient received elective surgical care at the closest hospital offering the requested procedure or another nonlocal hospital. Bypass probability was then modeled as a function of patient-level and hospital-level characteristics.

RESULTS

Of the 121,297 rural elective surgery visits in our sample, 78,268 (64.5%) bypassed their local hospital. Bypass rate was greatest for coronary artery bypass graft or valve replacement (74.8%) and lowest for laparoscopic cholecystectomy (53.7%). In addition, average bypass rate was greatest for surgeries with the highest risk of intraoperative blood loss and postoperative complications. The probability of bypass significantly (P < .001) increased for patients who were younger, privately insured, and lived farther from the closest hospital. In addition, the probability of bypass significantly (P < .001) increased for patients whose local hospital had fewer full-time equivalents, lower operating margin, and fewer recommendations from previous patients.

CONCLUSION

Among rural patients seeking elective surgery, bypass of the local hospital was common among both low-risk and high-risk procedures. These findings suggest that there is a substantial amount of bypass, which may negatively impact a hospital's financial performance and, hence, wellbeing of the local community.

Estimation method for distance cost to access medical services: Policy and patient privacy implications in Taiwan

Introduction

Indicators of healthcare access with high reliability, validity, timeliness, and easy application can aid in an understanding of the supply and demand of a region's medical resources and assist governments in allocating resources more effectively. However, a key concern when developing indicators is the protection of private information, such as patients' residential addresses.

Objectives

We develop an estimation method for distance cost using official public information, including a region's disease prevalence rates and population.

Materials and methods

The method accounts for patients' privacy and addresses limitations associated with using the National Health Insurance Database. This cross-sectional study conducts a secondary data analysis using SPSS and QGIS. The data were divided into a validation group and an index development group with the medical distance calculated for each group. Data for the validation group were sourced from the medical records of patients with diabetes (n = 108-164) and hypertension (n = 243-348) in Yuli documented by a medical center in 2017-2019, and the data for the novel index development group included diabetes and hypertension prevalence sourced from national official public data. The study compared the consistency of the two groups' medical treatment distances to verify the accuracy of the estimation method.

Results

The estimated distances for the index development group showed a high consistency (ICC > 0.9). Further, the index development group had an excellent R-square after adjusting for age (98.1%) and gender (92.7%).

Conclusions

The proposed method to estimate healthcare on the basis of disease prevalence and population protects patient privacy and can be implemented by local governments.

Trial registration

This study was approved by the Research Ethics Committee of the Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (IRB109-239-B).

Differential effects of distance decay on hospital inpatient visits among subpopulations in Florida, USA

Understanding patients' travel behavior for seeking hospital care is fundamental for understanding healthcare market and planning for resource allocation. However, few studies examined the issue comprehensively across populations by geographical, demographic, and health insurance characteristics. Based on the 2011 State Inpatient Database in Florida, this study modeled patients' travel patterns for hospital inpatient care across geographic areas (by average affluence, urbanicity) and calendar seasons, and across subpopulations (by age, gender, race/ethnicity, and health insurance status). Overall, travel patterns for all subpopulations were best captured by the log-logistic function. Patients in more affluent areas and rural areas tended to travel longer for hospital inpatient care, so did the younger, whites, and privately insured. Longer travel distances may be a necessity for rural patients to cope with lack of accessibility for local hospital care, but for the other population groups, it may indicate rather better mobility and more healthcare choices. The results can be used in various healthcare analyses such as accessibility assessment, hospital service area delineation, and healthcare resource planning.

Understanding variations in Medicare Consumer Assessment of Health Care Providers and Systems scores: California as an example

OBJECTIVE

To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California.

STUDY DESIGN/DATA COLLECTION

Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation.

PRINCIPAL FINDINGS

California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages.

CONCLUSIONS

This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population.

Illness severity and propensity to travel along the urban-rural continuum

In this paper, we examine whether the relationship between severity of illness and the propensity to travel greater distance relative to the norm (defined by peers in one's county of residence) is uniform across the urban-rural continuum of geography or over time. We focus on the elderly in New York State who have been admitted to hospital for ambulatory care sensitive conditions (ACSCs), admissions which are presumed to be representative of usual travel patterns. The two periods of time examined span the implementation of the Balanced Budget Act (BBA) of 1997, which established the Medicare Rural Hospital Flexibility Program, a major national initiative to strengthen rural health care with the development of rural Critical Access Hospitals (CAHs). As the number of NY rural hospitals certified as CAH increased with the expanded funding from the BBA, one might expect to see increased distance traveled by more severely ill rural elderly, as their CAHs referred them to their affiliated support hospitals. The logistic regression estimates support this expectation, highlighting an asymmetrical relationship between relative distance and severity across patients in rural and urban areas. Despite a general decline in average propensity to travel further than the norm across the landscape, severity had a larger impact on travel propensity in rural areas, which increased over time.