Cross-city patient mobility and healthcare equity and efficiency: Evidence from Hefei, China. (July 2022)

• Record Type: Journal Article
• Authors: Yan, Xiang; Shan, Lu; He, Shenjing; Zhang, Jiekui
• Is Part Of: Travel behaviour and society. Volume 28(2022)
• Page Start: 1
• Page End: 12
• Publication Date: 2022-07
• Subjects: Patient mobility -- Social inequity -- Efficiency -- Healthcare utilization -- Healthcare reform; Transportation -- Periodicals; Population geography -- Periodicals; 303.48305
• DOI: 10.1016/j.tbs.2022.02.001
• Languages: English
• ISSNs: 2214-367X

Abstract

Highlights: Patient mobility is mutually constitutive with the healthcare system in a dynamic manner. The examination of individual patient mobility should be positioned in the hierarchical healthcare delivery system. Patient mobility leads to another dimension of social inequality associated with uneven distributions of healthcare resources. Female, older adults and other marginal groups travel longer distances for healthcare. Policies indirectly encouraging patient mobility produce mixed outcomes in healthcare efficiency. Abstract: Recent studies on healthcare accessibility have made use of medical records to study the actual patient mobility and its implications for healthcare governance. Drawing on 39, 067 cross-city healthcare utilization records of Hefei residents in China between 2019 and 2020, this study extends existing research to examine patient mobility at individual level and its impacts on healthcare equity and efficiency in a hierarchical healthcare delivery system. The results show that 29.62, 30.63, and 39.75 percent of cross-city healthcare utilization was to access China's top 100 hospitals, Tertiary-A hospitals, and other hospitals respectively, with significantly different distance decay patterns. The multivariate regression models revealed that patient mobility leads to another dimension of social inequality associated with uneven distributions of healthcare resources. Females, older adults, and holders of Basic Medical Insurance of Urban and Rural Residents were disadvantaged in traveling long distances for cross-city healthcare. More inequities in gender and insurance type were found in cross-city utilization of low-level hospitals. The difference-in-difference analysis found that policies indirectly encouraging patient mobility produce mixed outcomes in healthcare efficiency, resulting in cost-saving for patients' utilization of China's top 100 hospitals but cost increase for the use of other hospitals. Conceptually, this study presents a novel and meaningful attempt to understand patient mobility, and underscores the need for context-sensitive and dynamic approaches to unraveling the mutual constitution between patient mobility and healthcare system.