Equitable access to elective hospital services: The introduction of patient choice in a decentralised healthcare system

Ringard, Ånen

doi:10.1177/1403494811418277

Cited by 12 publications

(13 citation statements)

References 13 publications

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“…There are two possible reasons for this: One is that the government has established a chronic disease management institution, which has increased the reimbursement rate for patients with chronic diseases in primary medical institutions in order to encourage patients to visit these facilities, and the other is that primary medical institutions use drugs according to the basic drug catalog. Simultaneously, the implementation of a zero‐profit drug policy reduces the price of drugs . Given that the elderly receive no work income, in order to alleviate their personal financial burden, they prefer primary medical institutions.…”

Section: Discussionmentioning

confidence: 99%

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

Zhang

Yang

2019

Health Planning & Management

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Background: Chronic diseases associated with diabetes threaten the health of Chinese people and contribute to poverty. Methods: Medical service utilization records of 78 124 visits by outpatients with diabetes to medical institutions in China's eastern region between 2013 and 2015 were randomly selected from the Medical Insurance Department (MID) database. One-way analysis of variance (ANOVA) was used to compare the average total per-visit, out-ofpocket (OOP), and medical insurance (MI) fund expenses between variables. Multiple linear regression analysis was performed to identify possible risk factors affecting total per-visit medical expenses. Results: Average total per-visit medical expenses were 244.59, 285.56, and 435.33 yuan in primary, secondary, and tertiary medical institutions, respectively. Significant differences were found for average total per-visit medical expenses by year of visit, age, type of medical insurance, and levels of medical institutions. No significant differences were found for average total per-visit medical expenses by gender. Conclusion: The functions of medical networks at all levels should be clarified and the Urban Resident Basic Medical Insurance (URBMI) reimbursement ratio improved to ensure equal access to medical services irrespective of medical insurance type. Patients with chronic diseases should be

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Section: Discussionmentioning

confidence: 99%

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

Zhang

Yang

2019

Health Planning & Management

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“…29 Other research has demonstrated that older patients and those with “good or very good” health were more likely to choose the hospitals where they were last treated. 31 A single-site EMS study of injured patients found that field providers initially focus on field trauma triage status, then typically ask patients where they would like to be transported for those not meeting triage criteria, with patient choice being a common reason for selecting hospital destinations. 11 The current study expands on previous research by further exploring the role of patient choice in selecting hospitals by EMS in multiple trauma systems.…”

Section: Discussionmentioning

confidence: 99%

“…Ringard et al demonstrated similar findings, with older, healthier patients tending to select specific hospitals for their care. 31 Such age-based selection bias combined with the inability of commonly measured variables to fully account for these prognostic differences may help explain the lack of measureable benefit of major trauma centers for older adults that exists for younger patients. 10 …”

Section: Discussionmentioning

confidence: 99%

Patient Choice in the Selection of Hospitals by 9-1-1 Emergency Medical Services Providers in Trauma Systems

et al. 2013

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Objectives Reasons for under-triage (transporting seriously injured patients to non-trauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. Methods This was a retrospective cohort study of injured children and adults transported by 61 EMS agencies to 93 hospitals (trauma and non-trauma centers) in five regions of the western United States from 2006 through 2008. Hospital records were probabilistically linked to EMS records using trauma registries, state discharge data, and emergency department (ED) data. The seven standardized reasons cited by EMS providers for selecting hospital destinations included: closest facility, ambulance diversion, physician choice, law enforcement choice, patient or family choice, specialty resource center, and other. “Serious injury” was defined as an Injury Severity Score (ISS) ≥ 16, and unadjusted in-hospital mortality was considered as a marker of prognosis. All analyses were stratified by age in 10-year increments, and descriptive statistics were used to characterize the findings. Results A total of 176,981 injured patients were evaluated and transported by EMS over the three-year period, of whom 5,752 (3.3%) had ISS ≥ 16, and 2,773 (1.6%) died. Patient or family choice (50.6%), closest facility (20.7%), and specialty resource center (15.2%) were the most common reasons indicated by EMS providers for selecting destination hospitals; these frequencies varied substantially by patient age. The frequency of patient or family choice increased with increasing age, from 36.4% among 21 to 30 year olds to 75.8% among those older than 90 years. This trend paralleled under-triage rates, and persisted when restricted to patients with serious injuries. Older patients with the worst prognoses were preferentially transported to major trauma centers, a finding that was not explained by field triage protocols. Conclusions Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age, and involves inherent differences in patient prognosis.

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“…In specialist and hospital care, there are as of yet no studies conducted in Sweden on how patient choice rights are used (which are weaker in this sector since they are not legally sanctioned) by different groups. Studies from other Nordic countries as well as the UK indicate, however, that the better-educated use this right more actively than those with lower education (Ringard, 2012;Birk et al, 2011;Dixon et al, 2010).…”

Section: Choice In Health Carementioning

confidence: 92%

The Political Role of Corporate Citizens

Helgesson¹,

Mörth²

2013

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Equitable access to elective hospital services: The introduction of patient choice in a decentralised healthcare system

Abstract: Hospital selection is a demanding task for many patients. Policymakers should therefore focus on crafting and implementing tools necessary for supporting uptake of choice in disadvantaged groups.

Cited by 12 publications

References 13 publications

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

Patient Choice in the Selection of Hospitals by 9-1-1 Emergency Medical Services Providers in Trauma Systems

The Political Role of Corporate Citizens

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