ITHACA, N.Y. --Rural patients enrolled in Medicare health maintenance organizations (HMOs) must travel up to 34 percent farther -- eight miles, or almost 10 minutes longer -- to reach a hospital than do traditional Medicare patients.

"Some patients must travel 90 minutes longer to go to a hospital in their network," says Liam O'Neill, assistant professor of policy analysis and management in Cornell University's College of Human Ecology. "Although 10 extra minutes may not seem significant, that's just the average time. Time and distance are not evenly distributed."

O'Neill looked at hospital travel time of 85,586 patients discharged from hospitals in rural Pennsylvania in 1998 to measure whether enrolling in a Medicare HMO significantly affects the time it takes to reach a hospital. The study is published in the June issue of Medical Care Research and Review (61:2, 187-202).

Previous studies had not found any significant differences in travel times among patients in HMOs compared with fee-for-service patients. The latest study suggests that being in an HMO is a factor when it comes to access to health care.

"Patients may be reluctant to see an out-of-network provider for emergency treatment. This may increase the risk of a bad outcome for certain time-sensitive conditions," says O'Neill, an expert in health-care systems. "Also, distance is a measure of access to health-care providers under managed care. Studies have shown that the farther you live from your healthcare provider, the fewer health services you use," he notes.

In many states, older people have the choice of whether to receive Medicare benefits through traditional Medicare or through a managed care plan. Steering patients into HMOs could be insignificant for distance to hospitals in metropolitan areas, O'Neill says, because hospitals are close by. However, steering rural patients into HMOs, the study suggests, means longer travel time to get critical care.

"When considering whether to join an HMO, geographical access could be a trade-off. Unfortunately, consumers are not always aware of this trade-off," O'Neill says.

The study was funded, in part, by the College of Human Ecology at Cornell.

Related World Wide Web sites: The following sites provide additional information on this news release. Some might not be part of the Cornell University community, and Cornell has no control over their content or availability.

oLiam O'Neill: http://www.human.cornell.edu/faculty/facultybio.cfm?netid=lo22&facs=1

oMedical Care Research and Review: http://www.ingenta.com/journals/browse/sage/j318