Distance to care and relative supply among pediatric
Michelle L. Mayer
, Heather A. Beil
, Daniel von Allmen
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill,
NC 27599, USA
Department of Health Policy and Management, School of Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, NC 27599, USA
Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Received 4 April 2008; revised 8 August 2008; accepted 11 August 2008
Geographic access to care
Background/Purpose: The aim of this study is to describe geographic proximity to and quantify relative
supply of 7 pediatric surgical specialties in the United States.
Methods: Data from the 2005 American Medical Association Physician Masterfile and the Claritas
Pop-Facts Database were used to calculate subspecialty-specific, population-weighted, straight-line
distances between each zip code centroid and the nearest provider. These same data sources were used
to calculate the percentage of hospital referral regions with a provider, the percentage of the younger
than 18 years population living within selected distances of providers, and provider-to-population
ratios for each of the pediatric surgical subspecialties. Further, we calculated the correlation between
practice locations and children's hospitals offering pediatric surgical services.
Results: Across pediatric surgical specialties, average distances to the nearest provider ranged from
27.1 miles for pediatric surgery to 100.9 miles for pediatric cardiothoracic surgery. The average
population-weighted distance to a provider was less than 30 miles for pediatric surgery and pediatric
ophthalmology only. For 5 of the 7 pediatric surgical specialties studied, approximately one quarter of
the younger than 18 years population lives more than 1-hour drive from a provider. Provider–to–
younger than 18 years population ratios range across hospital referral region from 0.04 per 100,000 for
pediatric cardiothoracic surgery to 0.97 per 100,000 for pediatric surgery. The correlation between
pediatric surgeons and children's hospitals offering services was 0.72.
Conclusions: Although the practice locations of pediatric surgical subspecialties parallel the geographic
distribution of children in the United States, large percentages of the younger than 18 years population
must travel long distance to receive care from these providers. Large coefficients of variation reveal
substantial maldistribution. These findings lay the groundwork for workforce assessments of the
pediatric surgical subspecialties and underscore the need for future studies that assess access barriers
for children in need of surgical care.
© 2009 Elsevier Inc. All rights reserved.
Corresponding author. Tel.: +1 919 966 7350; fax: +1 919 966 6961.
E-mail address: email@example.com (H.A. Beil).
0022-3468/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
Journal of Pediatric Surgery (2009) 44, 483–495