Severity of Illness, Race, and Choice of Local Versus Distant Hospitals Among the Elderly

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Abstract
This study examines travel patterns for hospitalization among elderly patients to address whether there are differences by age and race/ethnicity, and whether the differences persist even when a severe illness occurs. Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient database (SID) of the Agency for Healthcare Research and Quality, the study focuses on New York residents in the 65-and-over age group who are hospitalized in New York or neighboring states. Two types of hospital admissions are used: referral-sensitive admissions (fairly discretionary, high-technology procedures) and ambulatory care–sensitive admissions (avoidable with appropriate primary care). The study found that, after adjusting for other covariates, travel progressively declines with age among the elderly. Travel patterns across elderly age cohorts were not significantly different when patients were more severely ill. Members of racial/ethnic minority groups were less likely to travel than whites, and this gap persisted even when a severe illness occurred.