Impact of Local Resources on Hospitalization Patterns of Medicare Beneficiaries and Propensity to Travel Outside Local Markets


  • This research is funded wholly by the authors’ employers, the Agency for Healthcare Research and Quality and RTI International. The views expressed in this paper are those of the authors. No official endorsement by any agency of the federal government is intended or should be inferred. The authors would like to acknowledge the state data organizations that participate in the Healthcare Cost and Utilization Project State Inpatient Databases: the California Office of Statewide Health Planning and Development; the Florida Agency for Health Care Administration; the New York State Department of Health; and the Pennsylvania Health Care Cost Containment Council. For further information, contact: Jayasree Basu, PhD, MBA, Senior Economist and Senior Health Scientist Administrator, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850; e-mail


Purpose: To examine how local health care resources impact travel patterns of patients age 65 and older across the rural urban continuum.

Methods: Information on inpatient hospital discharges was drawn from complete 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New York, California, and Florida, and the 2003 hospital discharge file for Pennsylvania. The study population was Medicare patients with admissions for ambulatory care sensitive conditions. Analysis was at the patient-level, and area contextual variables were developed at the Primary Care Service Area (PCSA) level. Local resources considered included inpatient supply, provider supply, supply of international medical graduates, and critical access hospitals (CAHs) in the patient's PCSA.

Findings: Findings generally confirmed enhanced retention of the elderly in local markets with greater availability of community resources, although we observed considerable heterogeneity across states. Community resource variables such as median household income or inpatient hospital capacity were stronger and more consistent predictors along the urban rural continuum than any of the provider or CAH variables. Only in California and New York did we see significant effects for provider supply or CAH, but they were robust across the 2 states and models of travel propensity, always reducing the travel propensity.

Conclusions: Findings support policies aimed at augmenting supplies of critical access hospitals in rural communities, and increasing primary care physicians and hospital resources in both rural and urban communities.