Abstract
It is still open to debate whether increased availability and accessibility of physicians and health care services has a significant beneficial impact on the health status of populations in the United States. While there is convincing evidence that increased availability and accessibility has a significant beneficial impact on the health status of populations in developing countries (see, e.g., Lavy et al. 1996; Frankenberger 1995; Perry and Gesler 2000), a large body of literature suggests that additional resources spent on health do not significantly reduce mortality in the United States (Thornton 2002; Hadley 1982; Auster et al. 1969). A recent review of the literature on primary care and health in developed countries, however, suggests that the supply of primary care physicians is positively related to population health (Starfield et al. 2005). Moreover, medical care may not influence gross mortality but it may affect mortality rates of particular subgroups, the morbidity of the population, and preventative health behaviors (Anderson and Morrison 1989). In addition, spatial variations in the use and quality of medical care (Skinner 2006; Chan et al. 2006) may confound a simple link between access to health care and health care outcomes. The mixed evidence on the link between population health and health service provision and accessibility challenges policymakers who have to determine how to equitably allocate medical resources to improve public health, particularly in medically underserved areas.
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Notes
- 1.
For an overview, see Guagliardo (2004).
- 2.
Though extremely important on the supply side, lack of data does not allow us to refine supply to include physicians’ willingness to accept different types of patients (e.g., Medicare or Medicaid). The focus is thus solely on physical proximity to health care providers.
- 3.
Ambulatory care sensitive conditions are health care conditions evident when a patient is admitted for ambulatory care and presumed to be sensitive to the adequacy (availability) of ambulatory care.
- 4.
One notable exception is Shi et al. (2003) who used panel data to study the effect of primary care physician access on mortality.
- 5.
The standardization removes the effects of variations in mortality due to differences in the age composition.
- 6.
In this study the cause-specific mortality rates for the elderly are defined as all deaths due to a disease (independent of age) per 100,000 residents of age 55 or older. Thus, the events in the numerator do not perfectly match the population-at-risk in the denominator. However, for cancer and CVD it is quite rare that the events in the numerator involve people under the age of 55. In 2000, 93% of all deaths due to cardiovascular disease and 87% of all cancer deaths were among persons age 55 or older (U.S. National Center for Health Statistics, Vital Statistics of the United States, annual and National Vital Statistics Report, NSVR).
- 7.
In a preliminary analysis we also used an accessibility measure in which the service capacity is defined as a county’s total number of physicians, allocated to the hospital locations in proportion to the size of the hospital. While this is an approximation of the internal (within-county) spatial distribution of physicians, it does account for the tendency of physicians to locate close to hospitals so as to take advantage of agglomeration economies. Using access to physicians yields similar results as the results reported in this chapter.
- 8.
Note that, for the cumulative infant mortality model, the control variables are averages of the 1990 value and the value of the year specified in Table 2.
- 9.
The p-value refers to the test of \(\mathrm{{H}_{o} :\ E}(I) = -1/(n - 1)\) versus \(\mathrm{{H}_{1} :\ E}(I)\neq - 1/(n - 1)\) and is based on 999 permutations under the randomization assumption.
- 10.
We experimented with different specifications for the rurality variable, including nonlinearities. However, none of the non-linear specifications yielded significant results.
- 11.
Mortality statistics are, however, available publicly and thus are very useful for evaluation purposes.
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Acknowledgements
The research was conducted with partial support from the Purdue Center for Regional Development. The authors would like to thank Eda Unal and Sema Sobu for their research assistance, and three anonymous reviewers for their valuable comments.
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Waldorf, B.S., Che, S.E. (2010). Spatial Models of Health Outcomes and Health Behaviors: The Role of Health Care Accessibility and Availability. In: Páez, A., Gallo, J., Buliung, R., Dall'erba, S. (eds) Progress in Spatial Analysis. Advances in Spatial Science. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03326-1_16
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