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Utilization and health outcomes in a spatial model of the US health care system / by Laura C. Yasaitis.

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Author	Yasaitis, Laura C.
Title	Utilization and health outcomes in a spatial model of the US health care system / by Laura C. Yasaitis.
Date	2013
Abstract	Objectives: This dissertation comprises three essays on geographic variations in healthcare, and the association between utilization and health outcomes. I first explore associations between outpatient visits and Medicare beneficiaries' characteristics, regional physician supply and practice norms. I then develop ZIP code-level estimates of two health care services: HbAlc testing among Medicare diabetics, and the number of different physicians seen. Finally, with these measures, I test associations between local health care services and health outcomes. Methods: Study 1: Using 2006 and 2007 Medicare claims, and surveys of Medicare beneficiaries and physicians in 2005, I compared explanations for outpatient visit rates: beneficiaries' health and sociodemographics, and regional physician supply and practice norms. Study 2: An adaptive radius spatial smoothing technique, applied to Medicare data, ensured that each ZIP code-level estimate included at least 50 beneficiaries. Study 3: Functional health among Health and Retirement Study respondents was compared across quintiles of fine-grained measures from Study 2. Unadjusted associations were compared to those adjusted for respondents' demographics and socioeconomic status. Results: Study 1: Health status, care seeking preferences, and African American race significantly predicted beneficiaries' visits. Adjusting for all individual covariates explained less than 20% of the associations between visit rates and regional physician supply and practice norms. Study 2: Fine-grained variations exist across estimates of HbAlc testing rates for 30,786 ZIP codes in 1999 and 29,438 in 2009, and across estimates of different physicians seen for 36,761 ZIP codes in 2004. Study 3: Unadjusted results showed better health outcomes for those living in higher quintiles of each estimate from Study 2. In fully adjusted models, only 1999 HbAlc testing rates were significantly associated with better health. Conclusions: Study 1: Demand factors affect individuals' health care experi
Description	viii, 226 leaves : ill. 28 cm.
Format	application/pdf
Advisor	Jonathan S. Skinner, Julie P. W. Bynum, Amitabh Chandra, Elliott S. Fisher, Douglas O. Staiger, Sara L. McLafferty
College	Dartmouth Insititue for Health Policy and Clinical Practice.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.1015

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