Patterns of travel for rural individuals hospitalized in New York State: relationships between distance, destination, and case mix.

The travel patterns of individuals living in rural areas of New York State who were discharged from short-term general hospitals in New York State in 1983 are examined. Counties are used as the geographical unit, and rural individuals who cross geographic boundaries to obtain inpatient hospital care are compared with those who receive such care in their own geographic area. Hospital serving the rural population of New York are classified into three types: urban, consisting of all hospitals located in MSAs; rural referral centers; and other rural hospitals. Next, the rural patients who are admitted to each of these three types of hospitals are characterized in terms of distance traveled, case mix, length of stay, and age. Individuals who travel beyond the counties adjacent to their county of residence had a higher case mix index but were less likely to be more than 75 years old. Distance traveled and the expected cost of care were strongly positively related for patients admitted to urban and rural referral center hospitals, but were only weakly related for other rural hospitals. Finally, comparisons of rural patients in these three types of hospitals were performed adjusting for DRG mix, a comparison which is relevant to hospital reimbursements under the Medicare Prospective Payment System. Using several measures of illness severity, rural patients in urban hospitals and rural referral center hospitals were more severely ill than rural patients in other rural hospitals after adjusting for DRG mix. We conclude that somewhat higher payments to urban hospitals and rural referral center hospitals in New York are justified based on the more severely ill patients which they treat