Comparing Spatial Configurations: Hospital Service Areas and Disease Rates

Abstract

elaborate and advanced health care systems in the world. This system is characterized by an intricate hierarchy of physicians, group practices, clinics, ambulatory care centers, and hospitals of many sizes. While the proprietary physician is the actor with the leading role in almost every level of the American hierarchy, data regarding ambulatory care and patterns of referral for additional treatment which would serve as excellent indicators of health conditions are, in most instances, impossible to obtain. Still, much has been written about the spatial variability of health conditions within metropolitan areas. The two most commonly used surrogate measures are analyses of hospital service areas and medical geographies using public health data. While each method has distinct advan-