| Abstract: | ABSTRACT. In this paper a gravity model is formulated to model a hospital patient flow system. Both spatial and nonspatial measures of separation are used to estimate the model. Travel time was found to provide improved fits over linear distance in modeling patient flow behavior. Transformations of travel time (square root and log) were found to improve model performance further. Model diagnostics suggested additional spatial separation measurw, separation measure parameters demonstrated stability over time. The model is used to forecast the effects of health care financing reform and hospital closure on patient flows in an urban hospital market. Universal health coverage was found to dramatically improve access to hospital services for lower income patient populations. Hospitals at risk for closure were forecast to receive increased patient flows. Medical school hospitals are expected to lose patients after implementation of health reform, with important implications for graduate medical education. Hospital closures were shown to have negative effects on access to services in poor neighborhoods, but relatively little effect on access in the system as a whole. |
