Evaluation of Geographic Indices Describing Health Care Utilization
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초록
Objectives: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.
Abstract
Objectives: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.
참고문헌 (19)
- Thygesen LC, "Comparing variation across European countries: building geographical areas to provide sounder estimates", Eur J Public Health, 25(Suppl 1), pp.8~14 (2015)
- Volinn E, "Why does geographic variation in health care practices matter? (And seven questions to ask in evaluating studies on geographic variation)", Spine (Phila Pa 1976), 19(18 Suppl), pp.2092S~2100S (1994)
- 김민주, "The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization", 예방의학회지, 49(4), pp.230~239 (2016), 대한예방의학회
- Dartmouth Medical School, Center for the Evaluative Clinical Sciences, "The Dartmouth atlas of health care", pp.15~ (1996), American Hospital Pub
- Kilaru AS, "Do hospital service areas and hospital referral regions define discrete health care populations?", Med Care, 53(6), pp.510~516 (2015)
- Klauss G, "Hospital service areas -- a new tool for health care planning in Switzerland", BMC Health Serv Res, 5, pp.33~ (2005)
- Song YJ, "The South Korean health care system", Japan Med Assoc J, 52(3), pp.206~209 (2009)
- "Focus on health: geographic variations in health care" (2014)[URL]
- Tu JV, "Determinants of variations in coronary revascularization practices", CMAJ, 184(2), pp.179~186 (2012)
- "Improving patient decision-making in health care: a 2011 Dartmouth atlas report highlighting Minnesota" (2011)[URL]
- "Health at a glance 2015: OECD indicators"[URL]
- Wagner M, "Choosing caesarean section", Lancet, 356(9242), pp.1677~1680 (2000)
- Penna L, "Caesarean section for non-medical reasons", Int J Gynaecol Obstet, 82(3), pp.399~409 (2003)
- Simunovic N, "Surgery for hip fractures: does surgical delay affect outcomes?", Indian J Orthop, 45(1), pp.27~32 (2011)
- Moran CG, "Early mortality after hip fracture: is delay before surgery important?", J Bone Joint Surg Am, 87(3), pp.483~489 (2005)
- Bottle A, "Mortality associated with delay in operation after hip fracture: observational study", BMJ, 332(7547), pp.947~951 (2006)
- Turner P, "Fractured neck of the femur (DRG 210", 211): prospective outcome study, 1997, pp.67(2-3), 126~130
- Hawker GA, "Who, when, and why total joint replacement surgery? The patient’s perspective", Curr Opin Rheumatol, 18(5), pp.526~530 (2006)
- Openshaw S, "A million or so correlation coefficients: three experiments on the modifiable areal unit problem", Stat Appl Spat Sci, 21, pp.127~144 (1999)