Spatial Analysis of Health Care

Accessibility in Indiana

Susan Chen Brigitte Waldorf

Department of Agricultural EconomicsPurdue University

Contact:sechen@purdue.edu

Space, Health and Population Economics

SHaPE

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:

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

Spatial Variation in Health Care Services

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

Spatial Variation in Health Outcomes

Spatial Variation in Health Behaviors

Health Production Function (HPF)

Inputs:• Life style• Socio-economics• Environment• Genetic Endowment• Medical Resources

Health Outcome• Morbidity• Mortality

Health Production Function (HPF)

Inputs:• Life style• Socio-economics• Environment• Genetic Endowment• Medical Resources

Health Outcome• Morbidity• Mortality

Health Behaviors

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

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

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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

1. Health outcomes (mortality) are not influenced by medical resources, whether measured as availability of nurses or distance-based accessibility to hospital care.

Results

2. Healthcare availability (nurses per persons) has a beneficial effect on:

* % of pregnant women seeking prenatal care during the first trimester;

* teenage pregnancies.

Results

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

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

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)

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