Access to Care

Health insurance and access to primary care affect hospitalization of children outside their area of residence

Children who live in areas with a higher availability of primary care physicians (PCPs) and hospital-based outpatient services are less likely to go to hospitals outside their local area for ambulatory-care-sensitive (ACS) conditions such as asthma and diabetes. Hospitalizations for ACS conditions often can be prevented with good primary care, explain Jayasree Basu, Ph.D., and Bernard Friedman, Ph.D., of the Agency for Healthcare Research and Quality. Their study found that if there was one more PCP per 1,000 population in a county, children in that county were one-fifth as likely to use out-of-area hospitals for ACS conditions as children in a county where this increase did not occur.

A 10 percent increase in hospital outpatient capacity per capita and PCP physician supply per 1,000 population reduced the probabilities of out-of-area hospitalization by 5 and 3 percent, respectively. Also, a 10 percent increase in inpatient capacity in the patient's county reduced out-of-area hospital admissions by 3.5 percent.

Insurance also influenced out-of-county hospital admissions. Compared with privately insured children, Medicaid, health maintenance organization (HMO), and self-pay children had lower odds of using out-of-area hospitals. However, for Medicaid and HMO children, an increase in PCP supply reduced the probability of using out-of-area hospitals (odds ratio, OR 0.305 and 0.006, respectively). At an average level of 0.53 PCPs per 1,000 population, both HMO enrollees and Medicaid patients were likely to use local hospitals. For self-pay and privately insured patients, local primary care had no significant impact on the odds of going out of the county.

Greater severity of illness, proximity to a metropolitan area, and a higher county median income increased the likelihood of going outside one's county. These findings are based on an analysis of hospital discharge data for New York children admitted to hospitals in New York, Pennsylvania, New Jersey, and Connecticut in 1994. The researchers used logistic regression to predict travel out of the local area for ACS admissions based on factors of medical resources and patient characteristics.

More details are in "Preventable illness and out-of-area travel of children in New York counties," by Drs. Basu and Friedman in the January 2001 Health Economics 10, pp. 67-78.

Reprints (AHRQ Publication No. 01-R033) are available from the AHRQ Publications Clearinghouse.

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