The effect of spatial access on utilization of health care services among the elderly
Barriers exist between potential health care users and their actual access. Compared to other age groups, the elderly population faces more spatial obstacles to health care because of diminishing mobility. The object of this dissertation is to examine the extent to which spatial factors affect utilization of health care among the elderly. This dissertation investigates the main hypothesis that seniors who live in neighborhoods with high levels of spatial access will have higher levels of health care utilization. Data from the 2008 Texas physician record were applied to construct the indicator of spatial access using the Two-Step Floating Catchment Area method. This dissertation also used the Health and Retirement Study 2008 core and 2005-2009 American Community Survey 5-year data to estimate the average level of health care utilization as a function of spatial access and other individual and contextual characteristics. Results showed that older adults who lived in a Census tract with higher spatial access actually had lower mean values of health care utilization. After adding interaction terms, however, spatial access did have positive effect on health care utilization for seniors with very good or excellent health status compared to their counterparts who had fair or poor health status. The findings suggested that spatial access did influence seniors' health care utilization, but the effects varied by an individual's health status. Future studies should control for beneficial contextual factors that might potentially offset the effect of spatial access on health care utilization.