Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Walter J. Jones

Third Advisor

J. Dunc Williams, Jr.

Abstract

Access to care for out-of state Medicaid beneficiaries is known to be difficult as Medicaid programs are designed to work in state. An understanding of how these patients access care across state borders is important as without access, medical abandonment Medicaid beneficiaries can occur and create an additional health disparity solely based upon their geographic location and inability to access care locally. To determine the effects of crossing the state border for care we conducted a retrospective cross-sectional study using archival billing data for patients living in border counties without local hospitals that are contiguous with counties that have hospitals across state lines. We found that Medicaid beneficiaries are not crossing state borders to utilize the emergency department for non-emergent needs. Also, Medicaid beneficiaries in this study were less likely to cross the border for care in general. This lack of access to care resulted in these Medicaid beneficiaries likely withholding care until their illness had progressed to a more severe state, as evidenced by an almost 75 percent increase in the likelihood of death if admitted to the hospital. This study provides evidence that patient geography can become another health disparity, especially if the patient is a Medicaid beneficiary.

Rights

All rights reserved. Copyright is held by the author.

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