: Both distance to the hospital and hospital reputation influence patient choice of hospital; but the combined effect of these factors and how they relate to hospitalization outcomes has yet to be determined. The purpose of this study was to assess the combined influence of distance to hospital and hospital reputation on the hospitalization outcomes in patients with stroke. : This retrospective observational study utilized data from 69,107 stroke patients hospitalized in southern Chinese megacity between 2019 and 2021. A generalized linear model was used to assess the association between hospital reputation, distance to the hospital, hospitalization costs, and the length of stay. Multivariate logistic regression was used to estimate the combined effect on in-hospital mortality. : Compared with patients who chose hospitals without a good reputation and close to home, those who chose hospitals with a good reputation had lower hospitalization costs (-0.05; 95% CI: -0.08 to -0.02), a shorter length of stay (-0.18; 95% CI: -0.20 to -0.16), and lower in-hospital mortality (0.52; 95% CI: 0.40 to 0.67). However, patients who chose hospitals with a good reputation but farther distance experienced higher hospitalization costs (0.20; 95% CI: 0.17 to 0.23). : A shorter distance to the hospital and a higher reputation of the hospital are associated with lower costs and better outcomes. Our study indicates that improving outcomes for patients with stroke requires equitable distribution of quality medical resources.