Based on systematic observation and analysis of available evidence, we propose a typology of cross-border patient mobility (rather than the so-called ‘medical tourism’) defined as the movement of a ...patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions ‘why do patients go abroad for planned health care?’ and ‘how is care abroad paid for?’ Four types of patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of patient mobility each illustrated with international examples.
Inter-regional patient mobility represents both a resource and a challenge for the organization and financing of health systems, particularly in decentralised countries. We use cross-sectional time ...series regression analysis to test the determinants of imbalances in regional funds to finance inter-regional patient mobility for the 17 Spanish regions for the period 2014-2020. The findings indicate that highly specialised health centres and bilateral agreements partly explain the budget imbalance from inter-regional patient referrals, while local tourism partly explains the budget imbalance from non-referred patient mobility. Developing effective national schemes to compensate net patient recipient regions would be fundamental to addressing territorial imbalances.
Since 2007, Italian regions with healthcare budget deficits above a specific total funding threshold are obliged to commit to a financial recovery plan (FRP). We employ a quasi-experimental strategy ...to assess the consequences of FRPs on access to healthcare by identifying their impact on patient migration. We find a 24-31% increase in patient migration as a result of the strictest implementation of FRPs. Our empirical analysis shows that migration is affected by the regional availability of both capital and labour inputs.
An important aspect of the transnational lives of Polish migrants in the Netherlands is their frequent use of healthcare services in Poland. Transnational care use may be detrimental for the ...continuity and the quality of the care migrants receive. The current study aims to shed light on the antecedents of migrants' doctor visits in Poland. Drawing on a representative population-based sample of Polish migrants in the Netherlands (n = 1,082), logistic regression is used to assess whether length of stay in the Netherlands is negatively associated with the likelihood of doctor visits in Poland. The KHB decomposition method is used to determine the extent to which this potential association is mediated by three specific acculturation factors: ethnic identification, trust in the Dutch healthcare system and Dutch language proficiency. The models show that migrants who stayed in the Netherlands longer were less likely to visit doctors in Poland. Mediation analyses indicated that this effect was largely attributable to their greater Dutch language proficiency compared to their counterparts who arrived in the Netherlands more recently. Strong ethnic self-identification as Polish and lower trust in the Dutch healthcare system were also associated with a higher likelihood of visiting doctors in Poland. However, no significant mediation of the effect of length of stay via ethnic self-identification or Dutch language proficiency was found. The findings suggest that voluntary language programs may foster inclusion of Polish migrants in the Dutch healthcare system and reduce the need migrants perceive to seek care in their country of origin.
Abstract
Objectives
The Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was developed to screen a patient’s safe mobility level ‘in the moment’ and provide clinical ...decision support related to the use of safe patient handling and mobility (SPHM) equipment. This evidence-based flowchart tool is a common language tool that enables any healthcare worker at any time to accurately measure and communicate patient mobility and transfer equipment needs across disciplines and settings.
Methods
The VA MSST has four levels and differentiates between the need for powered and non-powered equipment depending on the patient’s independence. Subject matter experts wrote scenarios for interrater reliability and validity testing. The initial VA MSST draft iteration was reviewed by 163 VA staff (mostly physical therapists and occupational therapists) amongst simulation scenarios and provided content validity, and additional insight and suggestions. Revisions were made to create the final VA MSST which was evaluated by over 200 healthcare workers from varied disciplines (including medical doctors, advanced practice registered nurses, registered nurses, licensed practical nurses, certified nursing assistants, occupational therapists, physical therapists, speech therapists, radiology and ultrasound technicians, etc.). An instruction video and eighteen scenario videos were embedded in an online survey. The survey intended to demonstrate the interrater reliability and validity (concurrent and construct) of the VA MSST. Over 500 VA staff (raters) received a survey invitation via email.
Results
Raters (
N
= 230) from multiple disciplines and healthcare settings independently screened patient mobility status for each of 18 scenarios using the VA MSST. The raters were diverse in their age and years of experience. The estimated interrater reliability (IRR) for VA MSST was excellent and statistically significant with an estimated Krippendorff’s alpha (ICC (C, k)) of 0.998
95% CI
: 0.996–0.999. Eighty-two percent of raters reported that
overall
VA MSST instructions were clear or very clear and understandable. VA MSST ratings made by technicians and nursing assistants group correlated strongly (r = 0.99,
p
< 0.001) with the ‘gold standard’ (experienced physical therapists), suggesting a high concurrent validity of the tool. The VA MSST significantly discriminated between the different levels of patient mobility required for safe mobilization as intended (each difference,
p
< 0.0001); this suggests a good construct validity.
Conclusions
The VA MSST is an evidence-based flowchart screening and decision support tool that demonstrates excellent interrater reliability across disciplines and settings. VA MSST has strong face and content validity, as well as good concurrent and construct validity.
The absence of a referral system and patients' freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. ...This study aimed to determine factors associated with patient mobility rates within the provinces of Iran.
This cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran's provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software.
In the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility.
The distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.
Long-distance hospitalizations may represent an important phenomenon, especially with severe pathologies. In this work, we investigate patients’ elective admissions for cancers of the digestive ...system distinguishing between “local” hospitals (located in the region of residence) and “distant” hospitals (located in long-distances non-boundary regions). We model patient mobility towards alternative hospitals as a discrete choice process determined by geographical distance, clinical quality and other hospital-level characteristics and control for patients’ heterogeneity. We exploit data on admissions of patients residing in insular Italy, occurred in 2013 either locally or in central-northern hospitals, and estimate a willingness to travel of at least 14 km to be cured in a distant hospital for a quality increase from the 75th to the 25th percentile. Higher values are found for younger and more educated patients. Clinical quality does not affect the choice of local hospitals. Hospital choice significantly depends on characteristics that proxy hospital attractiveness, with differences between local and distant providers: commitment to research and private ownership show a positive role only for the latter.
This study explores the behaviour of hospitals in Lombardy in attracting patients from outside the region and investigates the effects on the quality of care to regional patients, where treatment of ...the latter is constrained by a budget cap while extra-regional patients represent an unconstrained source of revenue. The data suggest that hospitals use waiting time and length of stay to attract extra-regional patients. Regional patients in both private and public hospitals with higher proportions of extra-regional patients are characterized by lower mortality rates and reimbursement costs. These results suggest that the market for extra-regional patients has no negative effects on resident patients. Finally, the pattern of reimbursement for extra-regional care generates a financial flow in favour of wealthier regions, exacerbating the North–South divide in the National Health Service. Some form of regulation for extra-regional mobility is advisable to reduce the gap.
•We study the effects of patients mobility on quality and price for hospital care in Italy.•Hospitals attract patients from southern regions through better quality and from border regions through lower waiting times.•Resident patients are not discriminated and enjoy higher quality.•The price to treat patients from southern regions is higher than for resident.•Some form of regulation in cross border patients mobility might be advisable.
Using a 10-year (2006-15) regional dataset on hospital discharges, we estimate the determinants of Italian regional outflow rates while also including three proxies for social capital: the quality of ...friendships, the involvement in social activities and the ratio of blood donors to the population. We find a significant push effect from the lack of social capital intended as generalized expectation of cooperative behaviour (proxied by blood donors); this does not hold true for the other two proxies of social capital. The lack of a cultural context where norms of reciprocity matter may reduce regions' ability to retain their patients.
Waiting times for cancer treatments continue to increase in many countries. In this study we estimated potential ‘spare surgical capacity’ in the English NHS and identified regions more likely to ...have spare capacity based on patterns of patient mobility (the extent to which patients receive surgery at hospitals other than their nearest).
We identified patients who had an elective breast or colorectal cancer surgical resection between January 2016 and December 2018. We estimated each hospital's ‘maximum surgical capacity’ as the maximum 6-month moving average of its surgical volume. ‘Spare surgical capacity’ was estimated as the difference between maximum surgical capacity and observed surgical volume. We assessed the association between spare surgical capacity and whether a hospital performed more or fewer procedures than expected due to patient mobility as well as the association between spare surgical capacity and whether or not waiting times targets for treatment were likely to be met.
100,585 and 49,445 patients underwent breast and colorectal cancer surgery respectively. 67 of 166 hospitals (40.4%) providing breast cancer surgery and 82 of 163 hospitals (50.3%) providing colorectal cancer surgery used less than 80% of their maximum surgical capacity. Hospitals with a ‘net loss’ of patients to hospitals further away had more potential spare capacity than hospitals with a ‘net gain’ of patients (p < 0.001 for breast and p = 0.01 for colorectal cancer). At the national level, we projected an annual potential spare capacity of 8389 breast cancer and 4262 colorectal cancer surgical procedures, approximately 25% of the volumes actually performed.
Spare surgical capacity potentially exists in the present configuration of hospitals providing cancer surgery and requires regional allocation for efficient utilisation.
National Institute for Health Research.
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