Driving time drives the hospital choice: choice models for pelvic organ prolapse surgery in Italy.
Discrete choice analysis
Gynecological surgery
Hospital choice
Mixed logit model
Patient mobility
Pelvic organ prolapse
Journal
The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
21
05
2022
accepted:
22
12
2022
medline:
6
10
2023
pubmed:
12
1
2023
entrez:
11
1
2023
Statut:
ppublish
Résumé
The Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing pelvic organ prolapse (POP) surgery in Tuscany, Italy. We obtained the study population from Hospital Discharge Records. We duplicated individual observations (n = 2533) for the number of Tuscan hospitals that provided more than 30 POP interventions from 2017 to 2019 (n = 22) and merged them with the hospitals' list. We generated the dichotomous variable "hospital choice" assuming the value one when hospitals where patients underwent surgery coincided with one of the 22 hospitals. We performed mixed logit models to explore between-hospital patient choice, gradually adding the women's features as interactions. Patient choice was influenced by travel more than waiting times. A general preference for hospitals delivering higher volumes of interventions emerged. Interaction analyses showed that poorly educated women were less likely to choose distant hospitals and hospitals providing greater volumes of interventions compared to their counterpart. Women with multiple comorbidities more frequently chose hospitals with shorter average length of stay. Travel times were the main determinants of hospital choice. Other quality- and efficiency-related hospital attributes influenced hospital choice as well. However, the effect depended on the socioeconomic and clinical background of women. Managers and policymakers should consider these findings to understand how women behave in choosing providers and thus mitigate equity gaps.
Identifiants
pubmed: 36630004
doi: 10.1007/s10198-022-01563-6
pii: 10.1007/s10198-022-01563-6
pmc: PMC9833017
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1575-1586Subventions
Organisme : Regione Toscana
ID : No Award Number
Informations de copyright
© 2023. The Author(s).
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