A longitudinal examination of cross-region hospitalization and regional socio-economic status

Background: The objective of the study is to explore the socio-economic factors within the region that influence cross-regional hospitalization behavior in a longitudinal manner. Data Source: This study uses the longitudinal health insurance claims database during the period of 2004-2011. Method: Our main study region is New Taipei City, which has 29 districts and the largest population in Taiwan. We use the generalized linear mixed model (GLMM) to explore those factors influencing patients residing within New Taipei City to decide upon cross-regional hospitalization. The dependent variables are both the annual cross-regional hospitalization rate and the number of cross-regional hospitalizations within one year. These independent factors include patient characteristics and the socio-economic status of the 29 districts within New Taipei City, including the degree of urbanization and whether the Mass Rapid Transit (MRT) passes by. Result: The GLMM shows that both socio-economic variables have an insignificant impact on the number of cross-regional hospitalizations. Nevertheless, the comorbidity of individual patients has the effect on the cross-regional hospitalization rate (OR=1.04, P< 0.001) and the number of cross-regional hospitalizations (0.13, P < 0.001). Conclusion: This study has shown that a district's socio-economic status does not have pushing or pulling power for local residents who had the desire to seek hospitalization. However, one's health status may be the driving factor to push a patient to seek hospitalization outside the residential region due to rich medical resources. The planning and allocation of future medical resources should take patient comorbidity into consideration.