The use of health care services in Michigan, like their use in the United States as a whole, is highly localized. Most Americans use the services of physicians whose practices are nearby. Physicians, in turn, are usually affiliated with hospitals that are near their practices. As a result, when patients are admitted to hospitals, the admission generally takes place within a relatively short distance of where the patient lives. Although the distances from homes to hospitals vary with geography – people who live in rural areas travel farther than those who live in cities – in general most patients are admitted to a hospital which provides an appropriate level of care close to where they live.

The Medicare program maintains exhaustive records of hospitalizations, which makes it possible to define the patterns of use of hospital care. When Medicare enrollees are admitted to hospitals, the program’s records identify both the patients’ places of residence (by ZIP Code) and the hospitals where the admissions took place (by a unique numerical identifier). These files provide a reliable basis for determining the geographic pattern of health care use, because research shows that the migration patterns of patients in the Medicare program are similar to those for younger patients.

Medicare records of hospitalizations were used to define 3,436 geographically distinct hospital service areas in the United States. In each hospital service area, most of the care received by Medicare patients is provided by hospitals within the area. There are 109 of these hospital service areas in Michigan. The maps in this section show the location of each of these areas. Hospital service areas have been further aggregated into hospital referral regions, based on the pattern of use of cardiac surgery and neurosurgery. The maps also show the hospital referral regions to which the hospital service areas belong. There are 15 hospital referral regions in Michigan.

A detailed description of how hospital service areas and hospital referral regions were defined, and of the methodologies used to create the Dartmouth Atlas of Health Care in Michigan, is included in the Appendix on Methods.

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NOTICE TO ATLAS READERS
While not giving answers, the atlas raises questions about health care service use that merit careful consideration. "High" rates of use are not necessarily bad and "low" volumes good (or vice versa). Our goal is to move toward rates that are consistent with high quality health care, which need to be determined with local clinical, community and patient discussion and dialogue.

The atlas is not a physician or hospital report card. When reviewing data, note that the Hospital Service Areas in the atlas were defined by the atlas author. They may differ significantly from what a hospital considers its market area.