Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Modeling Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
BMC Health Serv Res. 2022 Dec 20;22(1):1556. doi: 10.1186/s12913-022-08972-6.
The absence of a referral system and patients' freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. This study aimed to determine factors associated with patient mobility rates within the provinces of Iran.
This cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran's provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software.
In the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility.
The distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.
伊朗缺乏转诊制度，患者可以自由选择服务提供者，这导致患者流动性增加，这仍然令该国的卫生政策制定者感到担忧。本研究旨在确定与伊朗各省患者流动率相关的因素。
本横断面研究在伊朗进行。收集了 2017 年 8 月入住伊朗公立医院的患者的居住地数据，以确定每个省的患者流动状况。样本量为 537786 名 2017 年 8 月在伊朗公立医院住院的患者。通过制作患者流动矩阵，为伊朗每个省计算患者流动率。然后，通过回归分析确定影响患者流动的因素模型。所有分析均使用 STATA14 软件进行。
在研究期间，有 585681 名患者入住伊朗公立医院，其中有 69692 名患者从另一个城市转诊到医院，有 51789 名患者入住省会公立医院。省内患者流动率最高的是南部和东部省份，最低的是伊朗北部和西部。实施负二项式回归表明，在所检查的参数中，专科医生的分布和人类发展指数对省内患者流动的影响最大。
专科医生在不同地区的分布对患者流动起着决定性的作用。在许多情况下，重新分配医院床位是不可能的，但通过在不同城市之间公平地重新分配专科医生，可以采取不同的人力资源政策，防止不必要的患者流动。
