Identifier

etd-08212015-140535

Degree

Doctor of Philosophy (PhD)

Department

Geography and Anthropology

Document Type

Dissertation

Abstract

Longer travel times to hospitals and other medical resources have been shown to be associated with decreasing health outcome and increasing mortality risk. Many countries have actively responded to the call of the World Health Organization (WHO) on creating local environments for the provision of and residents’ access to health resources. The hospital service areas (HSAs) and hospital referral regions (HRRs) have been proposed as more proper functional units for analysis of performance of healthcare market. However, the widely used Dartmouth HSAs and HRRs were produced solely based on two-decade-old Medicare hospitalization records. In this study, the effectiveness of the Dartmouth HSAs and HRRs are first evaluated. Based on the recent overall hospital discharge data, this study then examines the travel patterns for the overall population as well as subgroups (e.g., by race/ethnicity, socioeconomic status, and urbanicity) to identify the best-fitting distance decay function after comparing different models. The study goes on to delineate the new HSAs by the Huff model using the defined distance decay function. Finally, the travel patterns of patients for more specialized services are further modeled, and the results are utilized to define the new HRRs, which are further adjusted so that the HSAs are nested within the HRRs. Built upon the travel patterns of inpatient visits by different groups, the study enhances the theoretical foundation for defining an integrated and hierarchical system of HSAs-HRRs, and provides a scientific sound and easy-to-replicate research framework for delineation of HSAs that can benefit a variety of health care studies.

Date

2015

Document Availability at the Time of Submission

Secure the entire work for patent and/or proprietary purposes for a period of one year. Student has submitted appropriate documentation which states: During this period the copyright owner also agrees not to exercise her/his ownership rights, including public use in works, without prior authorization from LSU. At the end of the one year period, either we or LSU may request an automatic extension for one additional year. At the end of the one year secure period (or its extension, if such is requested), the work will be released for access worldwide.

Committee Chair

Wang, Fahui

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