An External Patient Healthcare Index (EPHI) for Simulating Spatial Tendencies in Healthcare Seeking Behavior

Area of Science:

• Healthcare resource allocation and spatial analysis
• Public health and health services research
• Geographic Information Systems (GIS) in health

Background:

• Limited healthcare resources necessitate efficient supply-demand matching.
• Unreasonable healthcare seeking behavior in China leads to resource over- and under-utilization.
• Limited research exists on the spatial distribution of healthcare utilization driven by patient spatial tendencies.

Purpose of the Study:

• To propose and validate a new External Patient Healthcare Index (EPHI) for simulating healthcare resource utilization.
• To identify patient spatial tendencies, including guest and bypass patients.
• To evaluate healthcare resource allocation efficiency by analyzing spatial utilization patterns.

Main Methods:

• Utilized the Two-Step Floating Catchment Area (2SFCA) method for spatial accessibility assessment.
• Developed the External Patient Healthcare Index (EPHI) using institution-level aggregated data (inpatient/outpatient visits).
• Compared estimated utilization (service provision) with expected utilization (population morbidity) to identify patient flows.
• Conducted a case study on China's Hainan Island to simulate and analyze spatial tendencies and resource allocation efficiency.

Main Results:

• The EPHI revealed widespread bypass activities on Hainan Island, with patients moving from less to more developed regions.
• Bypass activities resulted in under-utilization of healthcare resources in less developed areas and over-utilization in developed coastal regions.
• The index clearly identified sources and sinks of patient spatial tendencies.

Conclusions:

• The developed EPHI effectively identifies patient spatial tendencies and their impact on healthcare resource utilization.
• Combining EPHI results with spatial accessibility reveals the efficiency of healthcare supply-demand matching.
• Findings provide valuable insights for policymakers and healthcare providers to guide future resource allocation and investment.