Disparities in Geographic Access to Pediatric Subspecialty Care
- Michelle L. Mayer
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Purpose: To identify correlates of geographic access to pediatric medical subspecialists in the United States and identify characteristics of populations at risk for poor geographic access. Methods: Geographic access was operationalized as distance to care. Using data from the American Board of Pediatrics and the Claritas’ Pop-Facts Database, the straight-line distance between each zip code in the United States and the nearest subspecialist was calculated for each pediatric subspecialty using zip code centroids. Using 16 specialty-specific, random-effects multiple regression models, zip code characteristics associated with being farther from a subspecialty provider were identified. Results: Under-18 population, metropolitan status, and presence of a nearby teaching facility were associated with shorter distances to care across pediatric subspecialties. The proportion of the population below the federal poverty level was positively associated with greater distances to care. Zip codes in the Mountain and West North Central regions, likewise, were significantly farther from pediatric subspecialists, even when statistically controlling for other factors. Conclusions: Pediatric populations at risk for poor geographic access to pediatric subspecialty care include those who reside in zip codes with high concentrations of poverty, in rural and small metropolitan areas, and in the Mountain and West North Central regions. The extent to which these distances create barriers to receipt of care is not established.
- Mayer, M. L. (2006). Are we there yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics, 118(6), 2313–2321. CrossRef
- Rosenthal, M. B., Zaslavsky, A., & Newhouse, J. P. (2005). The geographic distribution of physicians revisited. Health Services Research, 40(6 Pt 1), 1931–1952. CrossRef
- Dionne, G., Langlois, A., & Lemire, N. (1987). More on the geographical distribution of physicians. Journal of Health Economics, 6(4), 365–374. CrossRef
- Schwartz, W. B., Newhouse, J. P., Bennett, B. W., & Williams, A. P. (1980). The changing geographic distribution of board-certified physicians. The New England Journal of Medicine, 303(18), 1032–1038. CrossRef
- Williams, A. P., Schwartz, W. B., Newhouse, J. P., & Bennett, B. W. (1983). How many miles to the doctor? The New England Journal of Medicine, 309(16), 958–963. CrossRef
- Newhouse, J. P. (1990). Geographic access to physician services. Annual Review of Public Health, 11, 207–230. CrossRef
- Newhouse, J. P., Williams, A. P., Bennett, B. W., & Schwartz, W. B. (1982). Does the geographical distribution of physicians reflect market failure? Bell Journal of Economics, 13(Autumn), 493–504. CrossRef
- Mayer, M. L., Skinner, A. C., & Slifkin, R. T. (2004). Unmet need for routine and specialty care: Data from the national survey of children with special health care needs. Pediatrics, 113(2), e109–e115. CrossRef
- Bureau of Health Professions. (2002). Area resource file. Quality Resource Systems, Inc.
- Claritas Inc. (2003). Pop-facts database for ZIP codes. San Diego: Claitas Inc.
- Guagliardo, M. F. (2004). Spatial accessibility of primary care: Concepts, methods and challenges. International Journal of Health Geographics, 3(1), 3. CrossRef
- Phibbs, C. S., & Luft, H. S. (1995). Correlation of travel time on roads versus straight line distance. Medical Care Research and Review, 52(4), 532–542. CrossRef
- Guagliardo, M. F., Jablonski, K. A., Joseph, J. G., & Goodman, D. C. (2004). Do pediatric hospitalizations have a unique geography? BMC Health Services Research, 4(1), 2. CrossRef
- American Association of Medical Colleges. (2005). COTH membership criteria. Available at: http://www.aamc.org/members/coth/membercriteria.htm. Accessed June 13.
- Guagliardo, M. F., & Ronzio, C. R. (2005). Is region of country a useful variable for child health studies? Pediatrics, 116(6), 1542–1545. CrossRef
- Limb, S., McManus, M., & Fox, H. (2001). Pediatric provider capacity for children with special health care needs: Results from a national survey of state title v directors. Washington DC: Maternal Child Health Policy Research Center.
- Cohn, R. J., Goodenough, B., Foreman, T., & Suneson, J. (2003). Hidden financial costs in treatment for childhood cancer: An Australian study of lifestyle implications for families absorbing out-of-pocket expenses. Journal of Pediatric Hematology/Oncology, 25(11), 854–863. CrossRef
- Odetola, F. O., Miller, W. C., Davis, M. M., & Bratton, S. L. (2005). The relationship between the location of pediatric intensive care unit facilities and child death from trauma: A county-level ecologic study. Journal of Pediatric, 147(1), 74–77. CrossRef
- Forrest, C. B., Nutting, P. A., von Schrader, S., Rohde, C., & Starfield, B. (2006). Primary care physician specialty referral decision making: Patient, physician, and health care system determinants. Medical Decision Making, 26(1), 76–85. CrossRef
- Federal Expert Work Group on Pediatric Subspecialty Care. (2006). Promising approches for strengthening the interface between primary and specialty pediatric care. Washington, D.C.: Maternal and Child Health Policy Research Center.
- Disparities in Geographic Access to Pediatric Subspecialty Care
Maternal and Child Health Journal
Volume 12, Issue 5 , pp 624-632
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Pediatric subspecialties
- Health care disparities
- Rural health services
- Health services accessibility
- Industry Sectors
- Michelle L. Mayer (1) (2)
- Author Affiliations
- 1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 2. Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, CB 7590, Chapel Hill, NC, 27599-7590, USA