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The Use of Health Service Areas for Measuring Provider Availability *
Author(s) -
M. Makuc Diane,
Haglund Bengt,
Ingram Deborah D.,
Kleinman Joel C.,
Feldman Jacob J.
Publication year - 1991
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.1991.tb01078.x
Subject(s) - residence , unit (ring theory) , service (business) , per capita , health care , population , business , service provider , medicine , cluster (spacecraft) , environmental health , geography , demography , economic growth , mathematics education , mathematics , marketing , sociology , computer science , economics , programming language
Measurement of the availability of health care providers in a geographic area is a useful component in assessing access to health care. One of the problems associated with the county provider‐to‐population ratio as a measure of availability is that patients frequently travel outside their counties of residence for health care, especially those residing in nonmetropolitan counties. Thus, in measuring the number of providers per capita, it is important that the geographic unit of analysis be a health service area. We have defined health care service areas for the coterminous United States, based on 1988 Medicare data on travel patterns between counties for routine hospital care. We used hierarchical cluster analysis to group counties into 802 service areas. More than one half of the service areas include only nonmetropolitan counties. The service areas vary substantially in the availability of health care resources as measured by physicians and hospital beds per 100,000 population. For almost all of the service areas, the majority of hospital stays by area residents occur within the service area. In contrast/for 39 percent of counties, the majority of hospital stays by county residents occur outside the county. Thus, the service areas area more appropriate georgraphic unit than the county for measuring the availability of health care.