Delineating Hierarchical Hospital Service Areas in Florida

Abstract

Hospital service area () and hospital referral region (), known as a hierarchical system, have been used as analysis units in a growing body of large‐scale studies of healthcare spending, utilization, and outcome in the United States. However, the popular Dartmouth s and s were produced more than two decades ago and are unable to represent contemporary healthcare markets. This research uses a revised Huff Model to delineate two levels of hospital service areas in Florida, resulting in sixty‐four s nested in twenty‐one s. Three elements distinguish our method from existing work. First, a best‐fitting distance‐decay function derived from the actual travel pattern of hospitalization is embedded in the Huff Model to strengthen the model's theoretical foundation in individual spatial behavior. Secondly, the hierarchal central place structure is supported by the differing travel‐friction coefficients for general versus specialized patients; general patients experience a steeper gradient and thus a shorter average travel range that supports delineating more s of smaller area size, and specialized patients exhibit a flatter gradient and thus a longer average travel range that leads to fewer s of large‐sized areas. Finally, the delineation method automated in geographic information systems () can be easily replicated in other regions to define large‐scale and consistent hierarchical systems.

Key words:

• distance‐decay function
• Huff Model
• hospital service areas (HSAs)
• hospital referral regions (HRRs)
• central place theory
• State Inpatient Database (SID)
• Florida

Jia would like to acknowledge Dissertation Fellowship support from the Graduate School of Louisiana State University.

Jia would like to acknowledge Dissertation Fellowship support from the Graduate School of Louisiana State University.

Notes

Jia would like to acknowledge Dissertation Fellowship support from the Graduate School of Louisiana State University.

Additional information

Funding

Graduate School of Louisiana State University

Notes on contributors

Peng Jia

Dr. Peng Jia Faculty of Geo‐Information Science and Earth Observation (ITC), University of Twente, Enschede 7500, The Netherlands; [[email protected]].

Fahui Wang

Dr. Fahui Wang (corresponding author) Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA; [[email protected]].

Imam M. Xierali

Dr. Imam M. Xierali Association of American Medical Colleges, Washington, DC, USA; [[email protected]].