Abstract
Purpose
The principles and methods of the geographical allocation of healthcare resources and their relationships with patient behavior have long been issues in the health policy research of many countries. This study aimed to investigate the associations between specific healthcare services such as surgical procedures and the behavior of patients in selecting hospitals that may be related to health service allocations under the relatively deregulated social health insurance settings in Japan.
Methods
A total of 520 976 discharge records were analyzed to examine the relationships between patient characteristics, primary diagnoses, interventions, distance to the hospitals of admission, and medical areas designated by local governments.
Results
Patients undergoing cardiac and orthopedic surgery were admitted to hospitals in distant medical areas more than twice as frequently and approximately 1.7 times as far from their residences compared to patients without such surgeries. In contrast, elderly patients and patients undergoing trauma or gastrointestinal surgery were admitted to nearby hospitals.
Conclusions
Patients who needed nonemergency and relatively complicated surgical interventions tended to be admitted to distant hospitals, thus suggesting that patients may select better hospitals for elective, technically demanding surgeries.
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References
Blank RH, Burau V. Setting priorities and allocating resources. In: Blank RH, Burau V. Comparative health policy. New York: Palgrave MacMillan; 2004. p. 87–121.
Welch HG, Larson EB, Welch WP. Could distance be a proxy for severity-of-illness? A comparison of hospital costs in distant and local patients. Health Serv Res 1993;28:441–458.
Basu J, Friedman B. A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity. Health Econ 2007;16:687–701.
Basu J, Mobleyb LR. Illness severity and propensity to travel along the urban-rural continuum. Health Places 2007;13:381–399.
White WD, Morrisey MA. Are patients traveling further? Int J Econ Bus 1998;5:203–221.
Adams EK, Houchens R, Wright GE, Robbins J. Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness. Health Serv Res 1991;26:583–612.
Tai WTC, Porell FW, Adams EK. Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient-physician relationship. Health Serv Res 2004;39:1903–1922.
Buczko, W. What affects rural beneficiaries’ use of urban and rural hospitals? Health Care Finan Rev 1992;14:107–114.
Hogan, C. Patterns of travel for individuals hospitalized in New York state: relationships between distance, destination, and case mix. J Rural Health 1988;4:29–41.
de Souza VC, Strachan DP. Relationship between travel time to the nearest hospital and survival from ruptured abdominal aortic aneurysms: record linkage study. J Public Health 2005;27:165–170.
Jones AP, Haynes R, Sauerzapf V, Crawford SM, Zhao H, Forman D. Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. Eur J Cancer 2008;44:992–999.
Varkevisser M, van der Geest SA. Why do patients bypass the nearest hospital? An empirical analysis for orthopedic care and neurosurgery in the Netherlands. Eur J Health Econ 2007;8:287–295.
Fushimi K. Hospitals in Japan: a general perspective. J Econ Med 2004;22:63–68.
Organization for Economic Co-operation and Development. Health at a glance 2007: OECD indicators. Paris; 2007.
Monden M. Changing society, evolving surgery. Surg Today 2008;38:195–205.
Yoshii N, Fushimi K. Factors influencing the selection of a hospital for colon cancer surgery in Japan: analysis of the effects of surgery volume, hospital functions, and geographic conditions. J Med Dent Sci 2006;53:167–174.
Ministry of Health, Labour and Welfare of Japan. Patient survey 1999 volume I. Tokyo; 2002.
Fushimi K, Hashimoto H, Imanaka Y, Kuwabara K, Horiguchi H, Ishikawa KB, et al. Functional mapping of hospitals by diagnosis-dominant case-mix analysis. BMC Health Serv Res 2007;7:50.
Ministry of Health, Labour and Welfare of Japan. Annual report on health, labour and welfare 2003–2004. Tokyo: Gyosei; 2005.
Tanihara S, Zhang T, Ojima T, Nakamura Y, Yanagawa H, Kobayashi M. Geographic distribution of medical supplies and the numbers of hospital inpatients in the secondary medical areas in Japan. Nippon Koshu Eisei Zasshi 1997;44:688–693.
Ozcan YA. Quantitative methods in health care management: techniques and applications. Hoboken: Jossey-Bass; 2005.
Siciliani L, Hurst J. Explaining waiting-time variations for elective surgery across OECD countries. OECD Econ Studies 2004;38:95–123.
Ikegami N, Campbell JC. Medical care in Japan. N Engl J Med 1995;19:1295–1299.
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Yamamoto, K., Fushimi, K. Travel of patients to distant hospitals for elective surgery in Japan: A cross-sectional analysis of a nationally representative sample. Surg Today 39, 758–763 (2009). https://doi.org/10.1007/s00595-009-3991-z
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DOI: https://doi.org/10.1007/s00595-009-3991-z