Doctor of Philosophy (PhD)


Geography and Anthropology

Document Type



Longer travel times to hospitals and other medical resources have been shown to be associated with decreasing health outcome and increasing mortality risk. Many countries have actively responded to the call of the World Health Organization (WHO) on creating local environments for the provision of and residents’ access to health resources. The hospital service areas (HSAs) and hospital referral regions (HRRs) have been proposed as more proper functional units for analysis of performance of healthcare market. However, the widely used Dartmouth HSAs and HRRs were produced solely based on two-decade-old Medicare hospitalization records. In this study, the effectiveness of the Dartmouth HSAs and HRRs are first evaluated. Based on the recent overall hospital discharge data, this study then examines the travel patterns for the overall population as well as subgroups (e.g., by race/ethnicity, socioeconomic status, and urbanicity) to identify the best-fitting distance decay function after comparing different models. The study goes on to delineate the new HSAs by the Huff model using the defined distance decay function. Finally, the travel patterns of patients for more specialized services are further modeled, and the results are utilized to define the new HRRs, which are further adjusted so that the HSAs are nested within the HRRs. Built upon the travel patterns of inpatient visits by different groups, the study enhances the theoretical foundation for defining an integrated and hierarchical system of HSAs-HRRs, and provides a scientific sound and easy-to-replicate research framework for delineation of HSAs that can benefit a variety of health care studies.



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Committee Chair

Wang, Fahui