However, patients who have similar comorbid conditions and advanced age but limited resources may not be able to travel to a tertiary care facility to undergo THA. Our data suggest that, on average, older, sicker patients with greater financial resources are able to travel far from home in order to receive the care that they require. Understanding the complex associations between these variables may allow improved predictions regarding which patients are more likely to travel great distances to receive care and why. It is likely that the demographic characteristics assessed in this analysis interact with one another in various ways. It is also possible that access for patients on Medicare in rural settings has declined with declining reimbursements, forcing these patients to travel farther, although more granular data are needed to define this relationship. In addition, individuals with higher income levels may be better positioned to take off time from work and other pursuits such as child care to travel a great distance to receive a joint replacement procedure than their less well-off counterparts. This may be due to the cost of transportation and lodging for family members accompanying patients. The present data also indicate that patients with greater financial resources are more likely to travel long distances to receive care. As noted previously, older individuals were found to be more likely to travel great distances to receive care. As most individuals begin to qualify for Medicare insurance at age 65 years, it is possible that the differences in insurance provider are based in large part on age. As such, it may be the case that White Americans are better able to deploy financial resources in order to travel to undergo surgical care far from their homes.
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