193599 Impact of patient travel time on social costs and efficiencies of hospitals

Monday, November 9, 2009

Patrick Bernet, PhD , Assistant Professor of Healthcare Management, Florida Atlantic University, Boca Raton, FL
James Moises, MD , Clinical Associate Professor of Emergency Medicine and Neuroscience, Tulane University, New Orleans, LA
Vivian Grace Valdmanis, PhD , Health Policy Program, University of the Sciences in Philadelphia, Philadelphia, PA
Research Issue:

An important aspect of access to care is geographic accessibility, which can be particularly problematic among the poor who have to rely on public transportation or less reliable forms of private transportation. Since these costs are borne by the patient, they are often not included in hospital cost studies. If geographical barriers impede timely access to care, these costs will be borne by society as a whole


In this research, we include both distance of patients to hospitals and hospital efficiency to measure performance and patient opportunity costs as an attempt to minimize social costs. Specifically, we assess where patients receive care for a non-urgent and urgent conditions. The health issue we wish to address is whether hospital ownership (public, Private Non-Profit, and Private For-profit) coupled with the patients' insurance coverage may provide insights to the total efficiency of hospital care.


To measure total efficiency we use the data envelopment approach (DEA). Patient distance is added as a social component to overall productivity as well as the hospital's individual production choices. We consider increasing patient distance, ceteris Paribas, as a social cost since delayed treatment could be injurious,adding to public health inefficiency. The DEA approach is flexible and avoids assumptions about the data which are often precarious in health care economic research.


Merged hospital capacity data from Florida Agency for Health Care Administration; Hospital Inpatient Discharge Data (patient characteristics) and Hospital Financial Data.


An increase in patient travel time directly impacted overall hospital inefficiency, indicating that there is a tradeoff between the social costs (travel time) and individual hospital efficiency. The social costs are also borne disproportionately by the lower income groups. Hospital ownership was also related suggesting that geographical cream skimming may also be an issue, particularly among for-profit hospitals.

Learning Objectives:
1. Assess relationship between patient travel time and hospital efficiency. 2. Evaluate the full range of patient costs of accessing care, including travel time.

Keywords: Hospitals, Access to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: PhD
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.