Providing medical care services to the uninsured continues to burden many safety net providers. While some states and localities have established funds to reimburse providers for care provided, others have designated the public hospital the provider of indigent care and raised tax funds for this purpose. As part of a community-based effort to re-structure care for the uninsured in Miami-Dade County, Florida, we examined how the County's provision of indigent care through funding the public hospital exclusively affects the travel patterns of the uninsured for hospital services.
Using 1998 hospital discharge data, we examined travel patterns of Miami-Dade County residents. For each patient, we determined the distance ranking (residence to hospital zip code) of all hospitals within the county and identified the rank of that hospital to which they were admitted. We compared these rankings across payer categories. Uninsured adults from South and West Dade were 3 times more likely than the commercially insured from these same areas to skip over 9 or more hospitals before being admitted, even for emergency hospital admissions. These differences were greater for children: uninsured children from South and West Dade were 6-7 times more likely than their commercially insured neighbors to skip over 9 or more hospitals before being admitted for emergency conditions. Moreover, uninsured patients who skipped over hospitals were often admitted to the public county hospital. Extra travel can delay care and make it difficult for families to provide social support to hospitalized patients, potentially affecting these patients negatively.
Learning Objectives: At the end of this presentation, the participant will be able to: 1. Describe how to analyze patient travel patterns. 2. Discuss how patient travel patterns reveal potential barriers to care. 3. Discuss how the organization and financing of care may affect geographic access to care.
Keywords: Access to Care, Vulnerable Populations
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.