Adams E K, Houchens R, Wright G E, Robbins J
SysteMetrics/McGraw-Hill, Lexington, MA 02173.
Health Serv Res. 1991 Dec;26(5):583-612.
Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individual characteristics on hospital choice, using McFadden's conditional logit model. Some patient characteristics have not previously been accounted for in this type of analysis. In particular, the effect of a patient's complexity of illness (as measured by Disease Staging) on the choice of hospital is taken into account. The data consist of over 12,000 Medicare discharges in three overlapping rural market areas during 1986. The hospital choice set was aggregated into seven groups of urban and rural hospitals. Results indicate that rural Medicare beneficiaries tend to choose hospitals with a large scope of service and with teaching activity over those with a lower scope of service and no teaching activity, holding other factors constant. Distance is a deterrent to hospital choice, especially for older Medicare beneficiaries. The more complex cases tend to choose larger urban and rural hospitals over small rural hospitals more often than less complex cases do.
先前的研究已经证实，理想的医院属性以及距离增加或旅行时间延长都会对医院选择产生影响。这些研究在选择建模方面变得越来越复杂。本研究通过使用麦克法登的条件逻辑模型来估计医院和个体特征对医院选择的影响，从而为现有文献增添了内容。在这类分析中，一些患者特征以前并未被考虑在内。特别是，考虑了患者疾病复杂性（通过疾病分期衡量）对医院选择的影响。数据包括1986年三个重叠农村市场区域内超过12000例医疗保险出院病例。医院选择集被汇总为七组城乡医院。结果表明，在其他因素不变的情况下，农村医疗保险受益人倾向于选择服务范围广且有教学活动的医院，而不是服务范围较小且没有教学活动的医院。距离是医院选择的一个阻碍因素，尤其是对老年医疗保险受益人而言。与病情不太复杂的病例相比，病情较复杂的病例更倾向于选择较大的城乡医院，而不是小型农村医院。
