Lee Moo Hyuk, Lee Ji-Su, Do Young Kyung
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.
Graduate School of Data Science, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
BMC Health Serv Res. 2025 Mar 19;25(1):407. doi: 10.1186/s12913-025-12464-8.
Public perception of healthcare quality reflects a people-centered approach to evaluating quality and influences healthcare utilization. Patient choice of healthcare providers is not solely based on objective measures, but varies with perceived quality factors such as experiences and trust. In South Korea, a large number of patients with severe diseases bypass their regional tertiary hospitals and receive treatment from a few tertiary hospitals located in the capital city Seoul: that is, they outmigrate. In this paper, we aimed to directly measure the public's feeling of reassurance with their regional healthcare system and examine it in explaining patient outmigration in South Korea.
The data of this study came from an online survey involving 1,241 individuals that was conducted in 2020 - 2021 to investigate healthcare-related perceptions of the public. Using stated preference data on hypothetical vignettes involving a cancer diagnosis, we measured outmigration and feeling of reassurance. We performed a logistic regression to assess the association between the two variables, controlling for tertiary hospital beds, distance to Seoul, and sociodemographic characteristics.
Among 581 respondents, 65.6% reported that there is a regional hospital they felt reassured to visit when diagnosed with cancer, while 63.5% were inclined towards outmigration to Seoul when they need surgery for lung cancer. There was a clear and robust negative association between outmigration and feeling of reassurance, where individuals who felt reassured with their regional healthcare system were 18.6% points less likely to outmigrate to Seoul.
Individuals' feeling of reassurance with the regional healthcare system plays a crucial role in outmigration in South Korea. These results emphasize the need to consider patients' subjective perception of quality in analyzing patients' decision-making and hospital choice. Policy efforts to alleviate the concentration of patients into Seoul should consider how the public perceives and interprets the regional-level quality of care.
公众对医疗质量的认知反映了以患者为中心的质量评估方法，并影响着医疗服务的利用。患者选择医疗服务提供者不仅仅基于客观指标，还会因诸如就医体验和信任等感知质量因素而有所不同。在韩国，大量重症患者绕过当地的三级医院，前往位于首都首尔的少数几家三级医院接受治疗，即他们选择外迁就医。在本文中，我们旨在直接衡量公众对当地医疗系统的安心程度，并探讨其对解释韩国患者外迁就医现象的作用。
本研究的数据来自于2020年至2021年对1241名个体进行的一项在线调查，该调查旨在探究公众对医疗相关方面的认知。利用关于癌症诊断的假设情景的陈述性偏好数据，我们衡量了外迁就医行为和安心程度。我们进行了逻辑回归分析，以评估这两个变量之间的关联，并控制了三级医院病床数量、到首尔的距离以及社会人口统计学特征。
在581名受访者中，65.6%的人表示当被诊断患有癌症时，有一家当地医院让他们感到安心前往就医，而63.5%的人在需要进行肺癌手术时倾向于外迁到首尔就医。外迁就医行为和安心程度之间存在明显且稳健的负相关关系，即对当地医疗系统感到安心的个体外迁到首尔就医的可能性降低了18.6个百分点。
个体对当地医疗系统的安心程度在韩国患者外迁就医现象中起着关键作用。这些结果强调在分析患者决策和医院选择时需要考虑患者对医疗质量的主观认知。缓解患者向首尔集中的政策措施应考虑公众如何看待和解读当地层面的医疗服务质量。
