Objective. Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization.

Design. Small area and population-based regression analysis.

Setting. The 72 hospital service areas of Maine, New Hampshire, and Vermont.

Study population. The 589 290 (1989) children of Maine, New Hampshire, and Vermont < 15 years of age with 120 806 discharges during 1985 through 1989.

Measurement and main results. Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant(P < .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence.

Conclusions. The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.

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