spatial analysis of health care accessibility in indiana susan chen brigitte waldorf department of...
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![Page 1: Spatial Analysis of Health Care Accessibility in Indiana Susan Chen Brigitte Waldorf Department of Agricultural Economics Purdue University Contact:sechen@purdue.edu](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d0a5503460f949dc1be/html5/thumbnails/1.jpg)
Spatial Analysis of Health Care
Accessibility in Indiana
Susan Chen Brigitte Waldorf
Department of Agricultural EconomicsPurdue University
Contact:[email protected]
Space, Health and Population Economics
SHaPE
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Federal Programs to Increase Accessibility
US 2005:
• $2.6 billion spent on improving accessibility to health care services
• 3,032 HPSAs in the USA
Indiana 2005:
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Research Aims
1. Pilot study using Indiana data
a. Design a measure of accessibility
(i) Use the measure to: Simulate policy changes Examine the effect on health outcomes
2. Expand study area to the United States and examine the changes over time
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Spatial Variation in Health Care Services
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Does availability / accessibility of health care services have a
beneficial impact on the health status of the population?
Developing Countries
1st to 2nd stage of epidemiological transition
Yes
Developed Countries
2nd to 3rd stage of epidemiological transition
Mixed Evidence
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Spatial Variation in Health Outcomes
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Spatial Variation in Health Behaviors
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Health Production Function (HPF)
Inputs:• Life style• Socio-economics• Environment• Genetic Endowment• Medical Resources
Health Outcome• Morbidity• Mortality
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Health Production Function (HPF)
Inputs:• Life style• Socio-economics• Environment• Genetic Endowment• Medical Resources
Health Outcome• Morbidity• Mortality
Health Behaviors
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Inputs of the HPF
Health Behaviors in Region i
Spatial Spillovers
Health Behaviors in Region j
Health Outcomes in Region i
Health Outcomes in Region j
Spatial Health Production Function
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Models
Estimated for n = 92 Indiana counties
Spatial weight matrix, W: 9292 spatial contiguity matrix:
(1) Non-spatial model: Y = Xβ + ε, ε ~ N(0,σ2)
(2a) Spatial error model: Y = Xβ + ε, and ε = λWε +μ , μ ~ N(0,σ2)
(2b) Spatial lag model: Y = ρWY+Xβ + ε or Y = (I-ρW)-1{Xβ+ε}
otherwise
bordercommonasharejiifikijw 0
/1
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VAR Variable Definition Data Source
INFCUM Infant mortality rate, 1990-2003Kids Count Indiana
PLBW03 % Low Birth Weight 2003
AEMORTAge-adjusted Elderly(55+) Mortality Rate 2003 Indiana Health
DepartmentELCVDR CVD Deaths per 100000 Elderly
ECANCR Cancer Deaths per 100,000 Elderly
SMOKE03 % Mothers smoking during pregnancy
Kids Count IndianaPRENAT03% Mothers Receiving Prenatal Care during 1st Trimester 2003
PKID02 % Kids with a Healthy Beginning 2002
TEENALL03Teenage Pregnancy Rate 2003 [births per 1,000 teenage girls]
Indiana Health Department
NURSEPP Nurses per 10,000 residents Stats Indiana
ACCHOSP Access to Hospital Care Unal et al. 2007
HHINC Medium Household Income [$1,000]Stats Indiana
PBS % Pop with BS+
PUNINS % Uninsured
IRR Index of Relative Rurality, 2000 Waldorf 2007
Health Outcomes
Health Behaviors
Controls
Availability
Accessibility
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1. Health outcomes (mortality) are not influenced by medical resources, whether measured as availability of nurses or distance-based accessibility to hospital care.
Results
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2. Healthcare availability (nurses per persons) has a beneficial effect on:
* % of pregnant women seeking prenatal care during the first trimester;
* teenage pregnancies.
Results
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3. We find evidence of spatial spillovers for:* cardiovascular disease mortality* smoking during pregnancy* prenatal care
cultures/norms of health behaviors diffuse across space.
Results
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Future Research Issues• Extend pilot study to a spatial analysis of all U.S.
counties even more pronounced disparities in health status as well as in spatial access to health care services.
• Spatial scale issues • Spatial structures, e.g. asymmetries
• Health outcome measures
• Over time
Changes in the supply of health services across time
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Simulations of Changes in Supply of Healthcare
Services• Closure of rural health clinics located within 10 miles from a hospital
• Closure of rural health clinics more than 15 miles from a hospital
• Increase in the capacity of hospital beds in three regional centers (Bloomington, Lafayette, and Fort Wayne)
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Closure of Health Clinics more than 15
miles awayCurrently - 18.2 % of rural clinics are located more than 15 miles from a hospital e.g. Martin, Brown, Davies, and Clay, Vermillion, Switzerland, Newton and Crawford
Policy Impacts – Southern counties along the Ohio River (band of counties from Clay to Crawford) will be most affected