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      Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers

      1 , 2 , 3
      Journal of Health Politics, Policy and Law
      Duke University Press

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          Abstract

          Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some.

          Methods: The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers.

          Findings: The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small.

          Conclusions: While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use.

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          Most cited references58

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          Traveling towards disease: transportation barriers to health care access.

          Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
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            Health Care Spending in the United States and Other High-Income Countries

            Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs.
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              A Nationwide Comparison of Driving Distance Versus Straight-Line Distance to Hospitals.

              Many geographic studies use distance as a simple measure of accessibility, risk, or disparity. Straight-line (Euclidean) distance is most often used because of the ease of its calculation. Actual travel distance over a road network is a superior alternative, although historically an expensive and labor-intensive undertaking. This is no longer true, as travel distance and travel time can be calculated directly from commercial Web sites, without the need to own or purchase specialized geographic information system software or street files. Taking advantage of this feature, we compare straight-line and travel distance and travel time to community hospitals from a representative sample of more than 66,000 locations in the fifty states of the United States, the District of Columbia, and Puerto Rico. The measures are very highly correlated (r(2) > 0.9), but important local exceptions can be found near shorelines and other physical barriers. We conclude that for nonemergency travel to hospitals, the added precision offered by the substitution of travel distance, travel time, or both for straight-line distance is largely inconsequential.
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                Author and article information

                Journal
                Journal of Health Politics, Policy and Law
                Duke University Press
                0361-6878
                1527-1927
                December 01 2020
                August 24 2020
                December 01 2020
                August 24 2020
                : 45
                : 6
                : 1107-1136
                Affiliations
                [1 ]Pennsylvania State University
                [2 ]University of Wisconsin–Madison
                [3 ]University of California Irvine
                Article
                10.1215/03616878-8641591
                73e4d604-68b5-4318-a942-f50762131f02
                © 2020
                History

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