Travel of patients to distant hospitals for elective surgery in Japan: A cross-sectional analysis of a nationally representative sample

The principles and methods of the geographical allocation of healthcare resources and their relationships with patient behavior have long been issues in the health policy research of many countries. This study aimed to investigate the associations between specific healthcare services such as surgical procedures and the behavior of patients in selecting hospitals that may be related to health service allocations under the relatively deregulated social health insurance settings in Japan. A total of 520 976 discharge records were analyzed to examine the relationships between patient characteristics, primary diagnoses, interventions, distance to the hospitals of admission, and medical areas designated by local governments. Patients undergoing cardiac and orthopedic surgery were admitted to hospitals in distant medical areas more than twice as frequently and approximately 1.7 times as far from their residences compared to patients without such surgeries. In contrast, elderly patients and patients undergoing trauma or gastrointestinal surgery were admitted to nearby hospitals. Patients who needed nonemergency and relatively complicated surgical interventions tended to be admitted to distant hospitals, thus suggesting that patients may select better hospitals for elective, technically demanding surgeries.