We examine travel distance and its effect on total and on avoidable hospitalizations, using data from three health regions in British Columbia, Canada. We conceptualize distance to hospital in geographic and socioeconomic contexts from the care seeker's perspective, and develop a GIS procedure to generate variables for these contexts. The procedure includes geocoding hospital locations and patient locations to determine travel distance for each hospitalization, generating several geographic barriers such as mountain crossings, and linking patient-neighborhood locations to socioeconomic variables. The findings reveal that overall, hospitalization rates are inversely related to distance to hospital. Even though low-income patients are more likely to be hospitalized for avoidable conditions, the income effect influences different dimensions from those affected by the distance effect. A balanced approach may be needed to address issues appropriately at both the low and the high ends of physical accessibility.
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