Patient Migration for Hospital Utilization: Case of Iran

Abstract

Introduction: Adequate information about patient using health care facilities is a critical element in planning activities and allocation resources in health sector. In Iran, with performing family physician plan and attempt to reform referral system, the study of mobility of patients between regions (patient migration) has more importance. The aims of the study are: 1) to describe patients' migration across cities of Iranian Kerman province; 2) to analyze the role of possible determinants affecting the mobility flows. Methodology: using hospital inpatient records of all public hospitals around Kerman province during 2011, we run logit models that compare patients who were admitted in hospital and received health services in cities where they lived and patients received them out of their local hospitals. We studied 21 patient groups according to ICD10 chapters (Appendix 1) to compute the effect of geographic distance, kind of insurance, number of physiccians involved, hospital bed and patient demographic factors. Results: About 40 percent of hospital admissions in Kerman are emigrant patients that quality or quantity of local provided services didn't satisfy. Constant negative coefficients of geographic distance, hospitals physician and bed and positive coefficients for insurance in all groups do not show any difference in patient migration, between groups. Discussion: According to results of this research, existence of local services, distance, kind of illness and other factors are not more important than patients' feeling about ser-* Corresponding author. A. Sabermahani et al. 837vices in their migration. Paying no attention to this reality in planning health system reforms, especially referral systems, leads to important problems for health system in equity, patient satisfaction and finance aspects.

Factors associated with patients’ mobility rates within the provinces of Iran

“…The fractional regression model indicated that an increase in the number of specialist physicians improves their dispersion and that their equitable distribution within the province is negatively correlated with intra-provincial mobility [ 37 ]. Similarly, the results of Saber-Mahani’s study in Iran showed that many patients are willing to leave their cities to receive the services of the doctors they trust and continue their treatment in another city [ 7 ].…”

“…Patient mobility is a significant issue for both patient-receiving and patient-sending areas as it can influence the pattern of health service provision and consumption in both places [ 5 , 6 ]. Patient mobility is defined as the patient’s mobilization from their place of living to another place, chosen freely by the patient or, occasionally, according to a doctor’s recommendation, to receive medical services [ 7 ]. Patient mobility usually occurs due to their freedom to choose a provider [ 8 ].…”

“…The referral system ensures fair access to services based on patients’ needs [ 9 ]. Patient mobility outside the referral system causes overloading of health facilities in patient-receiving areas and non-use of the capacities provided in the patient-sending areas [ 7 ]. Moreover, patient mobility creates dissatisfaction and additional social costs, such as travel and accommodation costs, for patients and their companions and prolonged absence from work for citizens who need to receive health care in another area [ 5 ].…”

“…In Iran, there is a robust private health sector delivering curative services. All cities with a population of over fifty thousand have at least one public hospital, whereas almost all private hospitals are located in provincial capitals [ 7 ]. Lastly, In Iran’s health system, due to the lack of a mandatory referral system, people can choose the service provider, the level of specialization, and the geographical location to receive the service [ 13 ].…”

The Access to Antenatal and Postpartum Care Services of Migrant Workers in the Greater Mekong Subregion: The Role of Acculturative Stress and Social Support

“…There is some evidence that immigration may benefit health. A person may make better use of health care, when migrating to areas with good health facilities [ 11 ]. Therefore, moving out from the mountain communities to the low-land urbanized areas in Thailand should improve accessibility to public health services.…”