HOSPITALIZATION FOR GASTROINTESTINAL AND LIVER-DISEASES - THE EFFECT OF SOCIOECONOMIC AND MEDICAL SUPPLY FACTORS

A growing body of research has documented significant variation in hea lth care use between communities. As the health care system is transfo rmed, providers and payers should understand the interaction between a community, its sociodemographic characteristics, and its use of healt h resources. We describe the association between a population's demogr aphic, socioeconomic, and medical resources and hospital use related t o gastrointestinal and liver diseases. We used an all-payer hospital d ischarge database for Michigan from 1986 to 1988. We identified all me dical and surgical hospital admissions during this period from two of the Diagnostic Related Group, Major Diagnostic Categories: No. 6, Dise ases and Disorders of the Digestive System; and No. 7, Diseases and Di sorders of the Hepatobiliary System and Pancreas. We analyzed age-and sex-specific use rates. Finally, we analyzed the influence of sociodem ographic variables from the Area Resource File at the county level, on hospital use, using a Poisson regression model. We noted a significan t association between increased hospitalizations and increased age in a community. Hospital beds per capita did not influence admission rate s overall, although more hospital beds were associated with more medic al admissions. Overall, the total physician supply was associated with more admissions. Finally, the most important socioeconomic variable w as education. As the level of education of a county increased, hospita l admissions decreased dramatically. The transformation of the health care delivery system presents opportunities and challenges. Understand ing the underlying epidemiology of disease and how it interacts with a community's socioeconomic and medical resources or medical supply cha racteristics will be necessary to meet the community's health needs an d to ensure the financial viability of providers. This is especially t rue when payers use a standard payment in a region, such as Medicare's managed care payment, without adjustments for the underlying populati on characteristics known to influence use.