Effects of distances to hospital and GP surgery on hospital inpatient episodes, controlling for needs and provision

Age and sex adjusted inpatient episode ratios were calculated from hospital records over a two year period for 555 census wards in Cambridgeshire, Nor folk and Suffolk, UK. Hospital episodes were divided into acute, psychiatri c and geriatric specialties, and elective and emergency acute admissions we re distinguished. Variations in inpatient episode ratios between wards were compared with census indicators of the 'needs' of local populations for in patient services, measures of the local provision of hospital and other rel ated services, and measures of the distance to the nearest general practiti oner surgery and the distance to the nearest hospital. Hospital episodes we re found to be strongly related to both distance measures, but the associat ions were partially explained by a tendency for the health status of local populations (measured by the needs indicators) to be worst in urban areas c lose to health services. Including needs and provision variables together w ith the distance variables explained most of the variations in age and sex adjusted inpatient ratios for small areas. Needs were the most important de terminants of emergency acute and psychiatric inpatient rates? but service provision was more important for elective acute and geriatric inpatients. C ontrolling for needs and provision, distance to hospital produced 17% reduc tion in acute episodes, 37% reduction in psychiatric episodes and 23% reduc tion in geriatric episodes over the range of distances observed. Distance t o nearest GP surgery reduced elective acute episodes by up to 15% after con trolling for confounders. These results demonstrate that the NHS is falling short of its aim to provide fair access to services irrespective of geogra phy, and new policies will be required if geographical inequities are to be reduced. (C) 1999 Elsevier Science Ltd. All rights reserved.