Health Policy | michelle ko md phd

Structured travel time and distance inequities in access to hospitals in the U.S. South

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White sign covers the existing sign of in front of a hospital and says "This hospital is CLOSED, if this is an emergency call 911." The sign is flanked by shrubs and lamps posts.

In 2019, a PhD student in medical geography at the University of Illinois posted on Twitter about her interest in studying rural hospital closures. An assistant professor from UC Davis DM’ed her to say, we should talk! They met up at a cafe near the AcademyHealth Annual Research Meeting in Washington, D.C. And a speedy 4 years, many datasets, analyses, a move, a new baby later…they finally published the first analysis.

Following up from her previous conceptualization on time as a social determinant of health, Arianna M. Planey uses the cases of access to acute care hospitals in the U.S. South to illustrate the construction of racialized inequities in healthcare.

In addition to grounding the motivation and analysis in the theoretical frameworks of structural racism and access to healthcare, Dr. Planey’s approach shows the benefits of drawing from geography methods to improve health services research, including:

Methodological improvements:

-Use of a validated hospital dataset that accounts for closures and mergers to determine actual losses of sites.

-Use of travel time/distance as an outcome. Most analyses of rural hospital closures, which use ‘container’ methods, e.g. documenting changes in hospital supply by county. In this manuscript, Dr. Planey examines travel time and travel distance. She shows that the impact on travel time and distance is relatively smaller than simply examining gains/losses by county.

-Estimates from the population-weighted centroids of Census tracts, i.e. not the geographic center (commonly used) but rather, based on where people live within the tract.

–Examination of both nearest and next-nearest hospital. This is a key consideration in rural hospital analyses, as community members have high rates of hospital bypass- for many reasons, including lack of specialty services and distrust of the nearest facility. For racially minoritized communities, the nearest hospital may not offer the services for linguistically, culturally appropriate care, which can include care that is respectful and trustworthy.

Findings: You can read more, TLDR Black and Latinx communities have longer travel times/distances to next nearest and nearest hospitals, despite being less remote than rural white communities.

And…what? you want to see what the impact is on access to care? Stay tuned….

Planey AM, Planey DA, Wong S, McLafferty SL, Ko MJ. Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018. Milbank Q. 2023 May 15. doi: 10.1111/1468-0009.12655. Epub ahead of print. PMID: 37190885

Time and space as operations of racism in healthcare

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In this piece, Arianna M. Planey explains how spatial access to healthcare arises from processes of structural racism, and thereby contributing to the impacts of time as a social determinant of health that produces racial inequities in healthcare access and outcomes.

“We discuss the potential for health/medical geography to contribute to a policy-relevant geographical research agenda that remains attentive to social theory debates. We illustrate the importance of time as a social determinant of health, through the case study of racial/ethnic inequities in spatial access to acute hospitals in the U.S. South region amid rural hospital closures, conversions, and mergers, which have decreased the supply of hospitals since 1990. In sum, racial disparities in spatial access were most pronounced for travel distances/times to the nearest alternative hospital, underscoring the importance of both temporal and spatial equity.”

Planey, A. M., Wong, S., Planey, D. A., & Ko, M. J. (2022). (Applied) geography, policy, & time: whither health and medical geography?. Space and Polity, 1-13.

https://doi.org/10.1080/13562576.2022.2098649

Declaring that DEI is important is not enough: We need action

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How to DEI

Three years in the making: a group of PhD students in health services and policy research (HSPR) set out to examine the workplace culture in the profession, with a particular eye to how our field fares with respect to diversity, equity and inclusion.

Bert Chantarat, Taylor Rogers, and Carmen Mitchell surveyed over 900 professionals and students, and conducted focus groups of those from historically and structurally excluded from the profession. In this publication ahead of print from Health Services Research, they report their findings from the survey:

“While the racial and ethnic diversity of the health services and policy research (HSPR) workforce has improved, significant gaps remain for groups historically and structurally excluded from health professions.

…

“HSPR workforce members experience non-inclusive, inequitable environments, with those from historically and structurally excluded groups reporting frequent discrimination.

“Those working in HSPR from historically and structurally excluded groups perceive their workplace DEI efforts to lack substance and focus on planning and reporting rather than implementation.”

“The field will not continue to improve toward creating a diverse workforce, and inclusive and equitable workplaces until a critical mass of people, especially leadership, begin working together seriously to address these issues. Declaring that DEI is important is not enough; effective actions must accompany such declarations.”

Check out the full article here:

Chantarat T, Rogers TB, Mitchell CR, Ko MJ. Perceptions of workplace climate and diversity, equity, and inclusion within health services and policy research. Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14032.