Is Growth in the Health Sector Correlated with Later-Life Migration?

  • Dayton M. LambertEmail author
  • Michael D. Wilcox
  • Christopher D. Clark
  • Brian Murphy
  • William M. Park
Part of the Advances in Spatial Science book series (ADVSPATIAL)


The aging population of the United States has long been a subject of debate and inquiry for development planners, policy makers, and researchers. The doubling of the population of Americans older than 65 since 1960 (while the population younger than 65 has grown by only one half) (Fuguitt et al. 2002), has prompted interest in their effect on the economies in which they live (Serow 2003) and their potential as a resource for rural economic development (Fagan 1988; Fagan and Longino 1993; Reeder 1998). Interest in these issues intensified as the baby boomer generation approached retirement age. The retirement of this age cohort is likely to have profound effects on the nation and its economy as this cohort is not only much larger than previous age cohorts, but also healthier and wealthier due to economic growth and advances in the quality of healthcare. Older Americans increasingly have the means and the motivation to migrate to a different area upon retirement. For example, it is estimated that over the next 18 years, approximately 400,000 retirees each year – with an average of $320,000 to spend on a new home – will choose to relocate beyond their state borders (Vestal 2006). The South and West have been and continue to be popular destinations for these migrants (Serow 2001; He and Schachter 2003), although more are choosing to locate outside of the traditional retirement areas of Florida and Arizona (Vestal 2006). One driving force of this shift is the “halfback” phenomenon in the Southeast where retirees who had previously migrated to the coast are returning halfway back to their ancestral homes by relocating to areas such as the Southern Appalachian mountain regions of eastern Tennessee, western North Carolina, and northern Georgia (Park et al. 2007). Further, later-life migrants are frequently settling in rural places or small towns (Fuguitt et al. 2002). For example, in 2000 a half million more persons above 60 moved into non-metro counties than out of them (Beale 2005). These trends beg the question of how the recent in-migration of older Americans is affecting local economies, particularly in rural areas where the marginal effect of in-migration may be proportionally greater than in more populous urban areas.


Health Care Service Health Care Sector Location Quotient Metropolitan County Area Resource File 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Aday RH, Miles LA (1982) Long-term impacts of rural migration of the elderly: implications for research. Gerontol 22:331–336CrossRefGoogle Scholar
  2. Anselin L (1988) Spatial econometrics: methods and models. Kluwer, LondonGoogle Scholar
  3. Anselin L (2002) Under the hood: issues in the specification and interpretation of spatial regression models. Agric Econ 27:247–267CrossRefGoogle Scholar
  4. Anselin L, Florax RJGM (1995) New directions in spatial econometrics. Springer, BerlinCrossRefGoogle Scholar
  5. Anselin L, Lozano-Gracia N (2007) Error in variables and spatial effects in hedonic house price models of ambient air quality. Empir Econ 34:5–34CrossRefGoogle Scholar
  6. Area Resource File (ARF) (2005) US Department of Health and Human Services, Health Resources and Services Administration. Bureau of Health Professions, Rockville, MDGoogle Scholar
  7. Bao S, Henry M, Barkley D (2004) Identifying urban-rural linkages: tests for spatial effects in the Carlino-Mills model. In: Anselin L, Florax RJGM, Rey SJ (eds) Advances in spatial econometrics: methodology, tools and applications. Springer, Berlin, 321–333Google Scholar
  8. Barsby S, Cox DR (1975) Interstate migration of the elderly: an economic analysis. Lexington Books, Lexington, MAGoogle Scholar
  9. Bates LJ, Santerre RE (2005) Do agglomeration economies exist in the hospital services industry. East Econ J 31:617–628Google Scholar
  10. Beale C (2005) Rural America as a retirement destination. Amber Waves (June)Google Scholar
  11. Beale CL, Fuguitt GV (1990) Decade of pessimistic nonmetro population trends ends on optimistic note. Rural Dev Perspect 20:4–18Google Scholar
  12. Boarnet MG, Chalermpong S, Geho E (2005) Specification issues in models of population and employment growth. Pap Reg Sci 84:21–46CrossRefGoogle Scholar
  13. Brasure M, Stearns SC, Norton EC, Ricketts T (1999) Competitive behavior in local physician markets. Med Care Res Rev 56:395–414CrossRefGoogle Scholar
  14. Capalbo SM, Heggem CN (1999) Innovations in the delivery of health care services to rural communities: telemedicine and limited-service hospitals. Rural Dev Perspec 14:8–15Google Scholar
  15. Cho S-H, Kim SG, Clark CD, Park WM (2007) Spatial analysis of rural economic development using a locally weighted regression model. Agric Res Econ Rev 36:24–38Google Scholar
  16. Cliff AD, Ord JK (1981) Spatial processes. Pion, LondonGoogle Scholar
  17. Cliff AD, Ord JK (1973) Spatial autocorrelation. Pion, LondonGoogle Scholar
  18. Cohen JP, Paul CM (2005) Agglomeration economies and industry location decisions: the impacts of spatial and industrial spillovers. Reg Sci Urban Econ 35:215–237CrossRefGoogle Scholar
  19. Colsher PL, Wallace RB (1990) Health and social antecedents of relocation in rural elderly persons. J Gerontol Soc Sci 45:S32–S38CrossRefGoogle Scholar
  20. Conley TG (1999) GMM Estimation with cross-sectional dependence. J Econ 92:1–45Google Scholar
  21. Connor RA, Hillson SD, Krawelski JE (1995) Competition, professional synergism, and the geographic distribution of rural physicians. Med Care 33:1067–1078CrossRefGoogle Scholar
  22. Day FA, Barlett JM (2000) Economic impact of retirement migration on the Texas Hill Country. J Appl Gerontol 19:78–94CrossRefGoogle Scholar
  23. Dine DD (1988) Demand for retirement housing accommodates industry growth. Mod Healthc 18: 56–60.Google Scholar
  24. Doeksen GA, Johnson T, Willoughby C (1996) Measuring the economic importance of the health sector on a local economy: a brief review and procedures to measure local impacts. Southern Rural Development Center, Starkville, MSGoogle Scholar
  25. Dwight MB (1985) Affluent elderly want to live where quality care’s readily available. Mod Healthc April:74–76Google Scholar
  26. Escarce JJ, Polsky D, Wozniak GD, Kletke PR (2000) HMO growth and the geographical redistribution of generalist and specialist physicians, 1987–1997. Health Serv Res 35:825–848Google Scholar
  27. Fagan M (1988) Attracting retirees for economic development. Center for Economic Development and Business Research, Jacksonville State UniversityGoogle Scholar
  28. Fagan M, Longino, Jr CF (1993) Migrating retirees: a source for economic development. Econ Dev Q 7:98–106CrossRefGoogle Scholar
  29. Freed GL, Nahra TA, Wheeler JR (2004) Relation of per capita income and gross domestic product to the supply and distribution of pediatricians in the United States. J Pediatr 144:723–728Google Scholar
  30. Fuguitt GV, Beale CL, Tordella SJ (2002) Recent trends in older population change and migration for nonmetro areas, 1970–2000. Rural Am 17:11–19Google Scholar
  31. Fujita M, Krugman P, Venables AJ (1999) The spatial economy: cities, regions, and international trade. MIT, CambridgeGoogle Scholar
  32. Glasgow N, Reeder RJ (1990) Economic and fiscal implications of nonmetropolitan retirement migration. J Appl Gerontol 9:433–451Google Scholar
  33. Haas WH III (1990) Retirement migration: boon or burden? J Appl Gerontol 9:387–392Google Scholar
  34. Haas WH, Crandall LA (1988) Physicians’ view of retirement migrants’ impact on rural medical practice. Gerontol 28:663–666CrossRefGoogle Scholar
  35. Haas WH III, Bradley DE, Longino CF Jr, Stoller EP, Serow WJ (2006) In retirement migration, who counts? A methodological question with economic policy implications. Gerontol 46:815–820CrossRefGoogle Scholar
  36. He W, Schachter JP (2003) Internal migration of the older population: 1995 to 2000. Census 2000 Special Report, US Census BureauGoogle Scholar
  37. Hodge G (1991) The economic impact of retirees on smaller communities. Res Aging 13:39–54CrossRefGoogle Scholar
  38. House JS, Lantz, PM, Herd P (2005) Continuity and change in the social stratification of aging and health over the life course. J Gerontol B Psychol Sci Soc Sci 60:15–26CrossRefGoogle Scholar
  39. Jiang HJ, Begun JW (2002) Dynamics of change in local physician supply: an ecological perspective. Soc Sci Med 54:1525–1541CrossRefGoogle Scholar
  40. Joseph AE, Bantock PR (1982) Measuring potential physical accessibility to general practitioners in rural areas: a method and case study. Soc Sci Med 16:85–90CrossRefGoogle Scholar
  41. Kelejian HH, Prucha IR (2007) HAC estimation in a spatial framework. J Econom 140:131–154CrossRefGoogle Scholar
  42. Lambert DM, McNamara K, Garret M (2006) Food industry investment flows: implications for rural development. Rev Reg Stud 36:140–162Google Scholar
  43. Loomis LM, Sorce P, Tyler PR (1989) A lifestyle analysis of healthy retirees and their interest in moving to a retirement community. J Hous Elder 5:19–35CrossRefGoogle Scholar
  44. McGranahan DA, Wojan TR, Lambert DM (2006) Rural growth as creative enterprise. Paper presented at the 53rd Annual North American Meetings of the Regional Science Association International, Toronto, Canada, Nov 16–18Google Scholar
  45. Mistretta MJ (2007) Differential effects of economic factors on specialist and family physician distribution in Illinois: a county-level analysis. J Rural Health 23:215–221CrossRefGoogle Scholar
  46. Monchuk DC, Miranowski JA, Hayes DJ, Babcock BA (2007) An Analysis of Regional Economic Growth in the U. S. Midwest. Rev Agric Econ 29:17–39CrossRefGoogle Scholar
  47. Moreno R, López-Bazo E, Vayá E, Artis M (2004) External effects and cost of production. In: Anselin L, Florax RJGM, Rey SJ (eds) Advances in spatial econometrics: methodology, tools and applications. Springer, Berlin, pp 297–317Google Scholar
  48. Mullins D, Rosentraub M (1992) Fiscal pressure? The impact of elder recruitment on local expenditures. Urban Aff Q 28:337–354CrossRefGoogle Scholar
  49. Newhouse JP, Williams AP, Bennett BW, Schwartz WB (1982) Does the geographical distribution of physicians reflect market failure. Bell J Econ 13:493–505CrossRefGoogle Scholar
  50. Park WM, Clark CD, Lambert DM, Wilcox MD (2007) The long-term impacts of retiree in-migration on rural areas: a case study of Cumberland County, Tennessee. The University of Tennessee Institute for Public Service, KnoxvilleGoogle Scholar
  51. Pathman DE, Ricketts TC III, Konrad TR (2006) How adults’ access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast. Health Serv Res 41:79–102CrossRefGoogle Scholar
  52. Patrick CH (1980) Health and migration of the elderly. Res Aging 2:233–241CrossRefGoogle Scholar
  53. Reardon J (1996) The presence of hospital systems in rural areas. J Econ Issues 30:859–876Google Scholar
  54. Reeder RJ (1998) Retiree-attraction policies for rural development. Agriculture Information Bulletin No. 741. U.S. Dept. of Agriculture, Economic Research Service, Washington, DCGoogle Scholar
  55. Reeder RJ, Glasgow N (1990) Nonmetro retirement counties: strengths and weaknesses. Rural Dev Perspect 20:15–30Google Scholar
  56. Regnier V, Gelwicks LE (1981) Preferred supportive services for middle to higher income retirement housing. Gerontol 21:54–58CrossRefGoogle Scholar
  57. Ricketts TC (2000) The changing nature of rural health care. Annu Rev Public Health 21:639–657CrossRefGoogle Scholar
  58. Rosenthal MB, Zaslavsky A, Newhouse JP (2005) The geographic distribution of physicians revisited. Health Serv Res 40:1931–1952CrossRefGoogle Scholar
  59. Rowles GD, Watkins JF (1993) Elderly migration and development in small communities. Growth Change 24:509–538CrossRefGoogle Scholar
  60. Serow WJ (2001) Retirement migration counties in the southeastern United States: geographic, demographic, and economic correlates. Gerontol 41:220–227CrossRefGoogle Scholar
  61. Serow WJ (2003) Economic consequences of retiree concentrations: a review of North American studies. Gerontol 43:897–903CrossRefGoogle Scholar
  62. Serow WJ, Charity DA (1988) Return migration of the elderly in the United States: recent trends. Res Aging 10:155–168CrossRefGoogle Scholar
  63. Sickles RC, Taubman P (1986) An analysis of the health and retirement status of the elderly. Econ 54:1339–1356CrossRefGoogle Scholar
  64. Stallmann JL, Deller SC, Shields M (1999) The economic and fiscal impact of aging retirees on a small rural region. Gerontol 39:599–610CrossRefGoogle Scholar
  65. Toseland R, Rasch J (1978) Factors contributing to older persons satisfaction with their communities. Gerontol 18:395–402CrossRefGoogle Scholar
  66. Vestal C (2006) Retirees boosting states’ rural economies. Available at:, 15 Sept. 2007
  67. Waldorf B (2006) A continuous multi-dimensional measure of rurality: moving beyond threshold measures. Paper presented at the Annual Meetings of the Association of Agricultural Economics, Long Beach, CA, JulyGoogle Scholar
  68. Wall TP, Brown LJ (2007) The urban and rural distribution of dentists, 2000. J Am Dent Assoc 138:1003–1011Google Scholar
  69. Wing P, Reynolds C (1988) The availability of physician services: a geographic analysis. Health Serv Res 23:649–67Google Scholar
  70. Whittle P (1954) On the stationary process in the plane. Biometrika 41:434–439Google Scholar
  71. Wojan TR, Lambert D, McGranahan DA (2008) Emoting with their feet: Bohemian attraction to creative milieu. J Econ Geogr 7:711–736CrossRefGoogle Scholar
  72. Wolinsky FD, Mosely II RR, Coe RM (1986) A cohort analysis of the use of health services by elderly Americans. J Health Soc Behav 27:209–219CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Dayton M. Lambert
    • 1
    Email author
  • Michael D. Wilcox
  • Christopher D. Clark
  • Brian Murphy
  • William M. Park
  1. 1.Department of Agricultural EconomicsUniversity of TennesseeKnoxvilleUSA

Personalised recommendations