Pediatric Cardiology

, Volume 40, Issue 8, pp 1599–1608 | Cite as

Minimum Travel Distance Among Publicly Insured Infants with Severe Congenital Heart Disease: Potential Impact of In-state Restrictions

  • Joyce L. WooEmail author
  • Brett R. Anderson
  • Daniel Gruenstein
  • Rena Conti
  • Kao-Ping Chua
Original Article


Travel distance to surgical centers may be increased when coverage restrictions prevent children with congenital heart disease (CHD) from receiving care at out-of-state congenital heart surgery centers. We estimated the minimum travel distance to congenital heart surgery centers among publicly insured infants with time-sensitive CHD surgical needs, under two different scenarios: if they were and were not restricted to in-state centers. Using 2012 Medicaid Analytic eXtract data from 40 states, we identified 4598 infants with CHD that require surgery in the first year of life. We calculated the minimum travel distance between patients’ homes and the nearest cardiac surgery center, assuming patients were and were not restricted to in-state centers. We used linear regression to identify demographic predictors of distance under both scenarios. When patients were not restricted to in-state centers, mean minimum travel distance was 43.7 miles, compared to 54.1 miles when they were restricted. For 5.9% of patients, the difference in travel distance under the two scenarios exceeded 50 miles. In six states, the difference in mean minimum travel distance exceeded 20 miles. Under both scenarios, distance was positively predicted by rural status, residence in middle-income zip codes, and white/non-Hispanic or American Indian/Alaskan Native race/ethnicity. For some publicly insured infants with severe CHD, facilitating the receipt of out-of-state care could mitigate access barriers. Existing efforts to regionalize care at fewer centers should be designed to avoid exacerbating access barriers among publicly insured CHD patients.


Congenital heart disease Health services research Ethics and policy 



The authors would like to thank Chuanhong Liao and Philip Schumm for their programming assistance.


Dr. Anderson receives Salary Support from the National Institutes of Health/National Heart Lung and Blood Institute (Grant Number K23 HL13343). The Medicaid Working Group at the University of Chicago provided funding for programming support. Dr. Chua is supported by a Career Development Award from the National Institute on Drug Abuse (Grant Number 1K08DA048110-01).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

246_2019_2193_MOESM1_ESM.docx (28 kb)
Supplementary file1 (DOCX 28 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric CardiologyColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Pediatrics, Section of CardiologyUniversity of Chicago Medical CenterChicagoUSA
  3. 3.Institute of Health System Innovation and Policy Markets, Public Policy, and LawBoston UniversityBostonUSA
  4. 4.Department of PediatricsUniversity of Michigan Medical CenterAnn ArborUSA

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