Spatial patterns of hospital utilization: the impact of distance and time.

Although the impact of the physical proximity of health care facilities on utilization in rural areas is well established, its effect in metropolitan areas is still subject to question. This paper develops a spatial demand model of hospital choice to empirically estimate the impacts of distance and time on hospital utilization patterns. With a cross-product ratio estimation approach, the effects of physical access are estimated after controlling for spatial irregularities owing to the distribution of hospitals and population in metropolitan areas. The empirical results suggest that distance and time factors strongly influence hospital choice, even in metropolitan areas where alternatives are widely available, and that their effects vary across service classifications and hospitals.