Identifying Determinants for Traveled Distance and Bypassing in Outpatient Care: A Scoping Review

Abstract

The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are willing to bypass the nearest physician. It was conducted according to the PRISMA extension for scoping reviews (PRISMA-ScR). Three databases (PubMed/Medline, ScienceDirect, and Ovid Medline) were searched, focusing on articles in which distance influenced the choice of physician. In all, 1,308 articles were accessed, and 17 selected for final review. First, we extracted methods for assessing distance traveled and bypassing. Second, we identified determinants that directly influence the traveled distance and transferred all into a conceptual framework. The center of this framework is the individual “willingness-to-go”, which reflects the willingness of patients to accept additional distances. Our findings can support studies on patient mobility and physician choice, which are essential for examining both the distribution and use of medical services, as well as for adequate need related planning.

The impact of patient–provider relationships on choosing between VA and VA‐purchased care: A qualitative study of health care decision‐making among rural veterans

“…This finding supports studies that demonstrate rural Veterans’ choices are not solely determined by where the provider is, but by their emotional connection to that provider and how they are treated in patient‐provider interactions 21,22 . It also supports other health services studies on non‐Veteran populations that demonstrate rural patients have a “willingness to travel” to obtain a preferred quality of care and patient–provider relationship 23 . Moreover, this finding builds on literature that suggests rural Veterans’ decisions where to seek care are personalized and complicated, in which rural identity and distance as a barrier are not uniformly defined and measured 2,24,25 …”

“…21,22 It also supports other health services studies on non-Veteran populations that demonstrate rural patients have a "willingness to travel" to obtain a preferred quality of care and patient-provider relationship. 23 Moreover, this finding builds on literature that suggests rural Veterans' decisions where to seek care are personalized and complicated, in which rural identity and distance as a barrier are not uniformly defined and measured. 2,24,25 Rural Veterans stressed the notion of stability when discussing their relationships with providers: the frustrations of changing providers and the benefits of having time and familiarity to build rapport.…”

Travel Time for Dental Care Services Based on Patient Preference in South Korea

“…Travel time, which is usually proportional to travel distance [ 46 ], is a cost for patients, especially when insurance coverage for healthcare services is comprehensive or the proportion of out-of-pocket expenses is not large [ 47 ]. Travel time also indicates the patient’s preference when selecting treatment [ 13 ].…”

Psoriasis care in Germany: do patients who receive better care travel longer?

“…Here, a conceptual framework was developed that identified different variables concerning access, quality of care, and the individual patient level as predictors for the willingness to travel further distances for medical treatment. We included those predictor variables on access, quality of care and the individual patient, that were available for the analysis [13]. The estimated travel time was the dependent variable.…”

“…In health systems with a free choice of provider, patients who are dissatisfied with their treatment tend to express their dissatisfaction by changing the physician [12]. Doing this, they often would accept long distances to the physician, which may be expressed as willingness-to-go [13]. Thus, determinants of travelled distance can be interpreted as indicators for what a patient values for his or her treatment.…”