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Border crossing for physician services: implications for controlling expenditures.

J Holahan¹, S Zuckerman

¹Urban Institute, Washington DC 20037.

Health Care Financing Review

|March 4, 1994

Summary

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Medicare beneficiaries cross state and local borders for physician services, with significant geographic variation. Rural areas import services, while urban areas export them, especially high-tech procedures.

Area of Science:

Health Services Research
Medical Economics
Geographic Health Access

Background:

Medicare physician services utilization exhibits geographic patterns.
Understanding patient travel for healthcare is crucial for policy development.

Purpose of the Study:

To analyze geographic border crossing patterns for Medicare physician services.
To identify variations in service utilization based on geographic location (State, urban/rural).

Main Methods:

Utilized the 1988 Part B Medicare Annual Data (BMAD) file.
Examined geographic variations in border crossing for physician services.

Main Results:

Substantial geographic variation observed in border crossing for Medicare services.

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Smaller geographic areas show more border crossing than entire States.

Rural areas predominantly import services; urban areas export services.

High-technology services (e.g., advanced imaging, oncology) exhibit greater border crossing.

Conclusions:

Geographic patterns of care significantly influence Medicare service utilization.
Expenditure-control policies should account for patient travel and existing geographic care patterns.