Analysis of Factors Influencing the Hospice in Rural Counties - Research Paper Example

ANALYSIS OF FACTORS INFLUENCING HOSPICE IN RURAL COUNTIES [Place your complete here] [Place here] [Place here] Introduction This paper focuses on the identification of the socioeconomic, physician-related, and rural-urban factors influencing the Medicare-certified hospice in the tree rural-urban areas from the 3,140 counties basing on the 2005 Area Resource File for county- level data base. In identifying the variables, the technique of local regression was used which was found to influence the Medicare-certified hospice across the chosen 3 rural-urban areas. According to the findings, the classification from metropolitan (least rural) to rural-nonadjacent (most rural), there was a decrease in the number of the physician rate, racial-ethnic diversity, as well as the number of counties having at least one Medicare-certified hospice. Given the increasing statistical figures of families and patients who certainly will be facing the end-of-life crisis or issues, access to the hospice care has been a significant consideration. It has been found that the rural communities have been found to get the least access to the hospice care or a Medicare - certified hospice. In addition, the higher the number of physician found in the community shall likely to have easy access to the Medicare -certified hospice such as the urban or metropolitan. Moreover, the study shows that the number of physicians that can work in a Medicare-certified hospice can lower because of the need for the physician's certification of terminal illness. Factors affecting the hospice The findings show that the racial-ethnic diversity decreases from most rural places to least rural places or as the classification of the rural to urban communities progressed. The following is the table of the summary of the rural-urban, socioeconomic and physician rate variables. The computation of the median has been appropriate for this study to avoid enumeration of the numerous census data. The purpose of the calculation of the median is to approximate the middle value of every entry in the table such as the total number of the whites that resides in certain location. Table gives the reader an idea that on the average, the population of the whites living in a particular location is 84.4 or simply 84.4%. Table 1. Summary of the rate of available physician, socioeconomic, and rural-urban classification The above table provides the summary f the characteristics of the 3,140 counties. In 204, the census of the average county was 93,507 with the standard deviation of 304, 790. In terms of the median age of each county, on the average, was 37.3 years with the standard deviation of the 4.01. This means that the median age varies within the limits of + 4.01 and -4.01 values. The mean percentage of the population of the counties pertaining to those people who are above 65 years old was 14.76% and with the standard deviation of 4.17. On the other hand, the statistics pertaining to the people classified as under poverty line is 13.74% with the standard deviation of 5.59. The mean percentage of the minority groups such as the Hispanics and African Americans in counties were 8.76% and 6.18% respectively. The Hispanics mean percentage derives a standard deviation of 11.9 while the African Americans, 14.5% standard deviation value. Furthermore, according to the summary of characteristics of the particular counties, the physician rate reaches 12.61% with a standard deviation of 14.89. On the other hand, the mean quantity of the Medicare-certified hospice was 0.83 with standard deviation of 1.84. The significance of the values 18.99, 8.99, and 9.48 pertain to the rates of physician in the rural-urban classifications. This means that the metropolitan (most urban or least rural) has the most number of physicians qualified to work with the Medicare-certified hospice than the adjacent metro or rural areas (see figure 1). Figure 1. A comparison of MDs per 10,000 census, mean percentage of poverty, of African Americans, of Hispanics, and counties with at least one Medicare-certified hospice across three rural-urban areas The percent rate of the people living below the poverty line is much lower as opposed to the percent rate of poor people living in the rural areas. The population of the African Americans is by far higher in the metro than the adjacent to metro places or rural locations. The metro areas have been found to have greater number of locations with at least one Medicare-certified hospice as compared to rural areas. Referring to the figure 2, the most counties did not have enough Medicare-certified hospices. The percent of counties having at least one Medicare-certified hospice can vary between urban and rural places such as the 59%, 39%, and 36% in metro, adjacent to the metro and non-adjacent to metro respectively. Table 2. Influence of Rurality, Socioeconomic Characteristics, and Availability of Physicians on the Presence of a Medicare-certified Hospice in a County The percentage of poor people as well as the physician rate was affected significantly by the county hospice. The odds of a certain county to have at least one Medicare-certified hospice was increased by 10% with the corresponding increase of the physician rate in the county (OR=1.105 or the p-value of less than 0.0005. The critical value used in this study was 0.05. The odds for the African Americans to have Medicare-certified hospice in the county were between 2% and 30%. The counties having the Hispanic population between the 2% and 15% composed the 23% of those that can have hospice care as compared with the population of less than 2%. Discussion Note the reason for conducting this study was to address the following questions: (1) What are some socioeconomic, rural-urban factors, and physician considerations that impact the availability of the Medicare-certified hospice (2) Are there distinctions or differences among the three rural-urban classifications The findings reported that at least one Medicare-certified hospice differed among the urban and rural places such that the statistics shows that in metro, the Medicare-certified hospice approached 59% while in adjacent metro, and the Medicare-certified hospice was 39%. These values correspond to the 0.001 which meant less than the previously set critical value of 0.05, significant difference of number of Medicare-certified hospice in metro as opposed to a number of hospices in adjacent metro as well as in non-adjacent metro. In other words, there are always greater numbers of hospices in more advanced and busy cities or counties as compared with those counties or locations that are considered rural. Thus, people can have easy access to the health services in times of need for medical attention and an emergency. With respect to the 3,140 counties considered under study, research shows that physicians rate vary from one county hospice to another most especially from metro to non metro, from rural to urban locations. The metro or the more modern counties, physicians are greater in number but the requirements for them to work in certain hospice become stricter as physicians are asked to secure licenses and certifications to prove that they can be trusted as well as by far competent to deal with end-of-life issues. The implication of this fact to particular hospices in various locations is that, physicians that do not have certifications to prove their credibility that they are capable of working as physicians; they might not be able to get payment. This happens in most rural areas, in this study, in non-adjacent to metro and adjacent to metro whereby there are scarcity of Medicare-certified hospices due to the fact that physicians lack the appropriate requirements to enable them to get permission to practice as health professionals. This is the reason that some areas, mostly rural places, do lack health clinics because of strict compliance with the guidelines set by counties that regulate health professionals requirements to ensure quality service to the needy. Evaluation/Criticism The author should have incorporated some of the basics of central tendency such as the mode as this is important in this study as well. The mode will give the readers idea as to which gender whose age falls above 65 years that normally avails the Medical-certified hospice. Additionally, there should have been further classifications as to which percent composes the aged female patients needing for the medical assistance as well as the average expenditures being subsidized by the government. The study should have specified how much the annual income, on the average, for a certain individual to be considered as poor or falling under the poverty line and what is the mean percent of these people that make up the metropolitan and the mean percent of the poor people making up the rural areas. The test statistics in this study was not shown and therefore, should have been computed such as the t-test or t-distribution as the data can be assumed to drawn from a normal population. The requirements for t-test to be used in research such as this are the necessity for assumptions that populations should be considered and taken randomly from the normal population. This means that the normal curve can be used in computing for the z scores equivalent to the computed probability or in this case, the p-value. There are several independent variables such as the gender of the participants (whites population), people deemed as poor, number of African Americans living in certain counties, and among others. These variables can be analyzed using the analysis of variances or one way analysis of variance. The assumptions made in this research were not clear as the statistical analysis used by the author as well is not mentioned except for basic components of central tendency being employed as part of the analysis such as the median and the mean which were appropriate for the data. The reason for its appropriateness is the fact that, the raw data reaches several thousands and this cannot be enumerated to the readers of the study but rather should be summarized by providing the representative statistic output such as median. References Buck, J. (2007). Netting the hospice butterfly: Politics, policy and translation of an ideal. Home Health Care Nurse, 25(9), 566-571. Bushy, A. (2008). 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