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Severity of illness and rural location affect the willingness of elderly people to travel longer distances to the hospital

Elderly people are generally disinclined to travel long distances for care. However, severity of illness, rural location, and available resources can affect their travel decisions, according to a new study of elderly people in New York. The study used an innovative measure of relative distance—propensity to travel further than one's neighbors—to gauge propensity for distant travel along the urban-rural continuum. The researchers focused the analysis on elderly New York residents who were hospitalized for ambulatory care sensitive conditions (those that can often be prevented by good primary care), which are assumed to be representative of usual travel patterns.

The researchers found that the overall willingness of the elderly to travel longer distances for care generally declined from 1997 to 2001. However, over time, more severely ill elderly people from isolated rural and adjacent rural areas were more likely to travel further than normal distances to hospitals, even in communities with new hospital entry. Those in isolated rural areas, who were least likely to travel long distances for care in 1997, demonstrated the greatest increase in travel propensities between 1997 and 2001.

The researchers, Jayasree Basu, Ph.D., M.B.A., of the Agency for Healthcare Research and Quality, and Lee R. Mobley, Ph.D., M.F.A., of Research Triangle Institute, note that two factors may have driven this trend. Medicare created rural Critical Access Hospitals (CAHs) in 1997, which were intended to be instrumental in managing the care of severely ill rural patients, and Medicare managed care penetrated farther into rural areas—both of which enhanced the ability to refer patients to more distant hospitals. The urban-rural disparity in travel distance to hospitals among the more severely ill elderly could have widened as the growing number of New York rural hospitals certified as CAHs (from three in 1997 to seven by 2001) referred the more severely ill patients to their affiliated support hospitals, explain the researchers.

More details are in "Illness severity and propensity to travel along the urban-rural continuum," by Drs. Basu and Mobley, in the May 2006 Health & Place (online). Reprints (AHRQ Publication No. 06-R077) are available from the AHRQ Publications Clearinghouse.

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