ESTIMATING THE EFFECTS OF TRAVEL DISTANCE AND COSTS ON EMERGENCY DEPARTMENT (ED) UTILIZATION: LEARNINGS FROM INDIVIDUAL LEVEL DATA

Yıl 2017, Cilt: 9 Sayı: 1, 64 - 76, 01.02.2017

İbrahim Demir M. Mahmud Khan

Öz

In recent years, Emergency Department (ED) visits have constituted approximately 10%
of annual health care spending in the United States (U.S.). Understanding the dynamics
of ED visits can help reduce overall spending on health care. This study analyzes the
effects of travel distance on ED visits to a southeastern county community hospital in the
U.S. between 2011 and 2015. Utilizing a zero-inflated negative binomial (ZINB)
estimation, the study found that travel distance significantly affected both the number and
probability of ED visits, ceteris paribus. The ED services are assumed to be “necessities”
with very low price elasticity when the medical condition is actually of a life threatening
type. If this assumption is true, then distance should have no impact on the probability of
visiting ED, ceteris paribus. Our results indicate that distance remains as an important
factor even when many different types of medical conditions have been incorporated in the model. This implies that ED visits are not considered as “absolute necessities” by
patients. Appropriate level of use of ED is not as rigid as often assumed and ED-seeking
behavior can be influenced by organizing alternative service channels in the geographic
region. For example, presence of community health workers, free clinics, school clinics,
and minute clinics can play important roles in reducing ED visits and associated health
care spending and costs. This study provides significant policy implications on how to
rationalize access to ED without adversely affecting health outcomes of the population.

Anahtar Kelimeler

Health spending, emergency department utilization, travel cost, distance decay