Neighborhood characteristics as determinants of healthcare utilization – a theoretical model

Sigrid M. Mohnen (), Sven Schneider () and Mariël Droomers ()
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Sigrid M. Mohnen: National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services
Sven Schneider: Heidelberg University
Mariël Droomers: Utrecht Municipality, Department of Public Health

Health Economics Review, 2019, vol. 9, issue 1, 1-9

Abstract: Abstract Background We propose using neighborhood characteristics as demand-related morbidity adjusters to improve prediction models such as the risk equalization model. Results Since the neighborhood has no explicit ‘place’ in healthcare demand models, we have developed the “Neighborhood and healthcare utilization model” to show how neighborhoods matter in healthcare utilization. Neighborhood may affect healthcare utilization via (1) the supply-side, (2) need, and (3) demand for healthcare – irrespective of need. Three pathways are examined in detail to explain how neighborhood characteristics influence healthcare utilization via need: the physiological, psychological and behavioral pathways. We underpin this theoretical model with literature on all relevant neighborhood characteristics relating to health and healthcare utilization. Conclusion Potential neighborhood characteristics for the risk equalization model include the degree of urbanization, public and open space, resources and facilities, green and blue space, environmental noise, air pollution, social capital, crime and violence, socioeconomic status, stability, and ethnic composition. Air pollution has already been successfully tested as an important predictive variable in a healthcare risk equalization model, and it might be opportune to add more neighborhood characteristics.

Keywords: Risk assessment; Prediction; Andersen model; Regional; Sociology; A120 Relation of Economics to Other Disciplines, I110 Analysis of Health Care Markets, G220 Insurance; Insurance Companies; Actuarial Studies, I130 Health Insurance, Public and Private, I180 Health: Government Policy; Regulation; Public Health, R00 General (Urban, Rural, Regional, Real Estate, and Transportation Economics) (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (2)

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DOI: 10.1186/s13561-019-0226-x

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