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Minimum Travel Distance Among Publicly Insured Infants with Severe Congenital Heart Disease: Potential Impact of In-state Restrictions

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Abstract

Travel distance to surgical centers may be increased when coverage restrictions prevent children with congenital heart disease (CHD) from receiving care at out-of-state congenital heart surgery centers. We estimated the minimum travel distance to congenital heart surgery centers among publicly insured infants with time-sensitive CHD surgical needs, under two different scenarios: if they were and were not restricted to in-state centers. Using 2012 Medicaid Analytic eXtract data from 40 states, we identified 4598 infants with CHD that require surgery in the first year of life. We calculated the minimum travel distance between patients’ homes and the nearest cardiac surgery center, assuming patients were and were not restricted to in-state centers. We used linear regression to identify demographic predictors of distance under both scenarios. When patients were not restricted to in-state centers, mean minimum travel distance was 43.7 miles, compared to 54.1 miles when they were restricted. For 5.9% of patients, the difference in travel distance under the two scenarios exceeded 50 miles. In six states, the difference in mean minimum travel distance exceeded 20 miles. Under both scenarios, distance was positively predicted by rural status, residence in middle-income zip codes, and white/non-Hispanic or American Indian/Alaskan Native race/ethnicity. For some publicly insured infants with severe CHD, facilitating the receipt of out-of-state care could mitigate access barriers. Existing efforts to regionalize care at fewer centers should be designed to avoid exacerbating access barriers among publicly insured CHD patients.

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Acknowledgements

The authors would like to thank Chuanhong Liao and Philip Schumm for their programming assistance.

Funding

Dr. Anderson receives Salary Support from the National Institutes of Health/National Heart Lung and Blood Institute (Grant Number K23 HL13343). The Medicaid Working Group at the University of Chicago provided funding for programming support. Dr. Chua is supported by a Career Development Award from the National Institute on Drug Abuse (Grant Number 1K08DA048110-01).

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA

    Joyce L. Woo & Brett R. Anderson

  2. Department of Pediatrics, Section of Cardiology, University of Chicago Medical Center, 5839 S. Maryland Ave, MC 4051, Chicago, IL, 60637, USA

    Daniel Gruenstein

  3. Institute of Health System Innovation and Policy Markets, Public Policy, and Law, Boston University, 595 Commonwealth Ave, Boston, MA, 02215, USA

    Rena Conti

  4. Department of Pediatrics, University of Michigan Medical Center, 300 North Ingalls, SPC 5456, Room 6E18, Ann Arbor, MI, 48109, USA

    Kao-Ping Chua

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  1. Joyce L. Woo
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Correspondence to Joyce L. Woo.

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Woo, J.L., Anderson, B.R., Gruenstein, D. et al. Minimum Travel Distance Among Publicly Insured Infants with Severe Congenital Heart Disease: Potential Impact of In-state Restrictions. Pediatr Cardiol 40, 1599–1608 (2019). https://doi.org/10.1007/s00246-019-02193-1

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