Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases
Goal: To understand the demand for health care by Mid-Shore residents in order to plan for a health care system that meets residents’ needs.
Objectives: • Where do residents of the Mid-Shore region go for health care? • Do residents in the region access care in the Mid-Shore region, in state or out of state? • For each county, do county residents access care in the county, the region, in state or out of state?
Approach: We used HSCRC hospital data, All Payer Claims Database, Medicare and Medicaid data to answer the questions above. We identify Mid Shore residents by zip codes, match to utilization databases, and identify visit location by provider zip code using the provider’s National Provider Identifier. All visits were assessed by type of visit: primary care, ER, inpatient.
Results: Mid-Shore residents have higher health care utilization relative to state averages. While most health care was accessed in the county of residence and in region, Medicare and Medicaid residents received more care locally compared to privately insured residents. Queen Anne’s residents are more likely to access care on the Western Shore, due to its proximity. Only about half of inpatient admissions are on the Mid-Shore, with less than 50 percent of privately insured residents staying in region. These patients have the transportation and other resources to access care based on reputation and specialized services offered by out-of-region hospitals.
Importance to public health: The findings reinforce the need to provide high-quality and accessible care on the Mid-Shore given that most residents access care locally for all their needs; and highlight the importance of maintaining and strengthening access to emergency room services on the Mid-Shore. The higher rates of inpatient admissions due to ambulatory sensitive conditions, across the region and particularly in Dorchester and Kent counties, indicate the need to reinforce ambulatory care locally. These results were shared with a Rural Health Workgroup and shared with the Legislature.