Analyzing Hospital Choices of Colon Cancer Patients in Four States in Appalachia

While geographic disparities in cancer treatment are documented, little research has investigated patients' willingness to travel longer distances for treatment at higher-quality hospitals. Even fewer studies have compared metropolitan and non-metropolitan patients on this dimension. Using population-based data from the Appalachian counties of four states, we identified all hospitals within a plausible driving distance of each newly diagnosed colon cancer patient and estimated conditional logit models of hospital choices for cancer surgery. Two sets of important findings emerged. First, both metropolitan and non-metropolitan patients chose higher-quality over lower-quality hospitals, and were willing to travel farther to use high-quality facilities. Second, non-metropolitan patients were not willing to travel farther than their metropolitan counterparts to hospitals that were more desirable along most dimensions, but non-metropolitan patients were willing to travel farther to high-volume hospitals. These findings show how travel distances to high-quality hospitals contribute to geographic disparities in colon cancer treatment.