Abstract
The principles and methods of geographical allocation of healthcare resources and their relationships with patient behavior have long been issues in health policy research in many countries. This study aimed to investigate the associations between patient and hospital factors and patient hospital selection behavior that may be related to health service allocation under the relatively de-regulated social health insurance settings in Japan.
Patient Survey data and DPC discharge records were combined and analyzed to examine the association between patient and characteristics, primary diagnoses, interventions and medical areas designated by local governments.
Patients admitted to hospitals in distant medical areas had a low case-mix index and short case-mix adjusted length of hospital stay. Admissions to distant medical areas were associated with age (odds = 0.762), male (1.067), use of ambulance (1.064), referral (1.158), transfer from other hospitals (1.268), diagnosis of infectious diseases (1.486), ophthalmology (1.276), mamma surgery (1.239), circulatory diseases (1.218), admission to large hospitals (1.571), and teaching hospitals (2.318).
The hospital selection behavior of patients needs to be taken into consideration to design health care plans and the health resource allocation for specialty care.
