Delineating hierarchical hospital service areas in Florida

Hospital service area () and hospital referral region (), known as a hierarchical system, have been used as analysis units in a growing body of large‐scale studies of healthcare spending, utilization, and outcome in the United States. However, the popular Dartmouth s and s were produced more than two decades ago and are unable to represent contemporary healthcare markets. This research uses a revised Huff Model to delineate two levels of hospital service areas in Florida, resulting in sixty‐four s nested in twenty‐one s. Three elements distinguish our method from existing work. First, a best‐fitting distance‐decay function derived from the actual travel pattern of hospitalization is embedded in the Huff Model to strengthen the model's theoretical foundation in individual spatial behavior. Secondly, the hierarchal central place structure is supported by the differing travel‐friction coefficients for general versus specialized patients; general patients experience a steeper gradient and thus a shorter average travel range that supports delineating more s of smaller area size, and specialized patients exhibit a flatter gradient and thus a longer average travel range that leads to fewer s of large‐sized areas. Finally, the delineation method automated in geographic information systems () can be easily replicated in other regions to define large‐scale and consistent hierarchical systems.