The purpose of the present
study is to use the U.S. News
rankings to identify the distribution of
hospital “centers of excellence” among
American metropolitan areas—both
in absolute and relative (per capita)
terms.
Table II continued
Area
2009 Population
Rank
Metro areas
A key aspect of the identification of hospital geographic distribution concerns the determination of
the involved metropolitan areas. The
United States Office of Management
and Budget (OMB) has defined a
“Metropolitan Statistical Area” (MSA)
as “one or more adjacent counties or
county equivalents that have at least
one urban core area of at least 50,000
population, plus adjacent territory
that has a high degree of social and
economic integration with the core as
measured by commuting ties.” There
are 366 such areas that have been identified by the OMB. 4
In addition to the Metropolitan
Statistical Area, the OMB has also
used the concept of “Combined
Statistical Area” (CSA). This has been
determined to exist where two or
more “core-based statistical areas”—
either an MSA or a “Micropolitan
Statistical Area”— have substantial
commuting ties. The OMB has identified 126 CSAs. 4
The Combined Statistical Area is
the most extensive of the area categories defined by OMB. While the population of a CSA is greater than any
of its core based components (which
often are MSAs) note that some
MSAs themselves—Miami, Phoenix,
San Diego, Tampa/St. Petersburg, and
Portland being the largest of these—
are treated as having only a single
urban core, and so have no associated
CSA identified.
It is significant to note that, of
the 983 citations in the 26 specialties
featured in the U.S. News rankings
(including the 10 children’s specialties), only one citation of qual-
Louisville
Jacksonville
Grand Rapids
Hartford
Memphis
Oklahoma City
Greenville, SC
Richmond
New Orleans
Birmingham
Buffalo
Albany
Rochester
Dayton
Fresno
Knoxville
Tucson
1,395,600
1,328, 100
1,327,400
1,313,500
1,304,900
1,297,600
1,264,900
1,238,200
1,235,700
1,212,800
1,203,500
1,151,700
1,127,500
1,066,300
1,063,900
1,053,600
1,020,200
Citations
(No.)
1
2
0
0
2
1
3
4
8
15
1
0
0
0
0
0
1
39
35
NR
NR
35
39
34
32
24
16
39
NR
NR
NR
NR
NR
39
Rank
(per capita)
42
36
NR
NR
35
41
33
32
12
3
39
NR
NR
NR
NR
NR
37
It is notable that many metro areas have only a few citations—and 10 have none
(including areas as large as Charlotte, Las Vegas, and Austin). At the same time—as
also seen in Table I—some “mid-size” metros have many cites.
ity involves a hospital not within a
Metropolitan Statistical Area. In fact,
a majority of hospitals cited fall also
within a CSA.
Method and findings
The initial approach used in the
present study is to list metropolitan
areas (either CSAs or MSAs where
the latter stand alone from any CSA)
in order of their 2009 estimated
populations (rounded to the nearest
hundred).
The number of hospital excel-
lence citations among the 16 basic
specialties and 10 children’s areas—
for a total of 982 citations in the 26
specialties—is then identified by
metropolitan area location. (A thresh-
old of five citations was deemed
appropriate for inclusion.) Then the
rank was determined—both in terms
of absolute number of citations and
number on a per-capita basis. Table I
displays the results of this procedure.
