Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Via San Zeno 2, 56127, Pisa, Italy.
Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
Eur J Health Econ. 2023 Dec;24(9):1575-1586. doi: 10.1007/s10198-022-01563-6. Epub 2023 Jan 11.
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.
意大利的医疗保健管辖范围促进了患者的流动性，这是实践差异的主要决定因素，因此与获得医疗服务的公平性有关。我们旨在探讨旅行时间、等待时间和其他与效率和质量相关的医院属性如何影响意大利托斯卡纳地区需要盆腔器官脱垂（POP）手术的女性对医院的选择。
我们从医院出院记录中获得了研究人群。我们为 2017 年至 2019 年提供超过 30 次 POP 干预的托斯卡纳医院数量（n=22）复制了个体观察（n=2533），并将其与医院名单合并。我们假设当患者接受手术的医院与 22 家医院中的一家相同时，将医院选择赋值为 1。我们进行了混合 Logit 模型分析，以探索医院间患者选择，并逐步将女性特征作为交互项加入。
患者选择更多地受到旅行时间的影响，而不是等待时间。对提供更高手术量的医院普遍存在偏好。交互分析表明，受教育程度较低的女性选择距离较远的医院和提供更多手术量的医院的可能性较小。患有多种合并症的女性更频繁地选择平均住院时间较短的医院。
旅行时间是医院选择的主要决定因素。其他与质量和效率相关的医院属性也影响医院选择。然而，这种影响取决于女性的社会经济和临床背景。管理者和政策制定者应考虑这些发现，以了解女性在选择提供者时的行为，从而减轻公平差距。
