Shop for quality or volume? which one is the pulling power for a patient's cross-regional hospitalization: A longitudinal analysis

Background: The objective of the study is to explore which important factor, hospital volume or hospital quality, that influences cross-regional hospitalization behavior in a longitudinal manner. Data Source: This study uses the longitudinal health insurance claims database of the Bureau of National Health Insurance (BNHI) that contains one million individuals randomly sampled during the period of 2004-2011. We analyze a representative sample of 217,865. The study identifies cross-regional hospitalization by comparing patients' place-of-residence (New Taipei City) and the locations of the hospitals they were admitted to. Method: Our main study region is New Taipei City, which has 29 districts and the largest population in Taiwan (around 20% of the country's total population). 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 hospital characteristics, encompassing hospital volume (per thousand persons), one-year inpatient hospital mortality (proxy for hospital quality), teaching status, and ownership. Result: The GLMM shows that one-year inpatient hospital mortality has insignificant impacts on the cross-regional hospitalization rate and the number of cross-regional hospitalizations. Nevertheless, the hospital volume does impact the number of cross-regional hospitalizations (0.11, P < 0.001). Conclusion: This study has shown that hospital quality may not have pulling power for patients who had the desire to seek hospitalization. However, the volume of a hospital may be the driving factor to push a patient to seek hospitalization outside the residential region. The planning and allocation of medical resources should consider both balancing the region's development and also the need to disclose more transparently the local hospital quality for patients seeking hospitalization.