Propper Carol, Damiani Michael, Leckie George, Dixon Jennifer
Department of Economics and CMPO, University of Bristol, Bristol, UK.
J Health Serv Res Policy. 2007 Jul;12(3):153-9. doi: 10.1258/135581907781543049.
To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status.
Using Hospital Episode Statistics for 2003-04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward.
There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards.
Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas.
比较在一项扩大患者选择的政策出台之前,英格兰各选区病房之间住院治疗的就诊距离,并考虑患者社会经济地位的影响。
利用2003 - 2004年的医院事件统计数据,计算每次入院时患者住所到国民健康服务医院的距离。将距离汇总到选区病房层面,以得出病房层面的就诊距离分布情况。对这些数据进行分析,以显示不同入院类型、患者年龄、农村/城市位置以及病房人口社会经济贫困程度的就诊距离。
各选区病房之间的住院就诊距离存在很大差异。部分差异可由地理位置解释:生活在农村地区的人因择期(中位数27.2公里对15.0公里)、急诊(25.3公里对13.9公里)和产科(25.0公里对13.9公里)入院而就诊距离更远。但生活在高度贫困病房的人就诊距离较短,而且这种较短距离不能简单地用医院离这些病房更近来解释。
在引入更多患者选择之前,人们在就医的就诊距离上存在很大差异。患者选择的增加可能会使来自贫困程度较低地区的人受益更多。