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Title: Determinants of Patient’s Choice to Bypass the Closest Hospital: A Case Study of Punjab, Pakistan
Authors: Samra Subhani, Abdul Majeed Nadeem, Sofia Anwar
Journal: Journal of South Asian Studies
Publisher: Center for Community Learning
Country: Pakistan
Year: 2022
Volume: 10
Issue: 1
Language: English
DOI: 10.33687/jsas.010.01.4200
Keywords: InequalityBypassPatient’s ChoiceTertertiary careRepute of hospital
Pakistan is a developing, 5 th populous country with recession in economic indicators. Bypassing is the phenomenon that is widely discussed among the low income countries due to the less provision of health care facilities at primary health care centers. Secondary healthcare centers provide specialized level of diagnostic and treatment facilities while tertiary care hospitals provide specialized healthcare facilities at advance level. There is an impression of better health service facilities at tertiary care hospitals as compared to primary and secondary healthcare hospitals located near the patient’s homes. So, they prefer to go to tertiary care hospitals after bypassing the closest secondary care hospitals. The objective of this study was to evaluate the factors that caused patients to bypass the closest hospital. A well-structured questionnaire was developed to collect data through a stratified random sampling technique. Data were collected from three major tertiary care hospitals of Faisalabad, Lahore, and Multan in Punjab province. The dependent variable was in dichotomous form so, binary logistic model was applied to see the effects of several independent variables such as patient’s demographic and behavioral factors that were consisted on problem of inequality, severity of disease, competency of doctor, reputation of hospital, availability of ambulance, availability of own transport facility, recommendation from friend, referred from primary health care. Results revealed that all these variables had a positive and significant relationship with the patient decision to bypass the closest hospital except residential area, competency of doctor and reputation of hospital. It is suggested that Government should take measures to upgrade the primary health care units to minimize the problem of bypassing the closest hospital. It will reduce the financial burden of patients that automatically enhance their well-being.
To evaluate the factors that cause patients to bypass the closest hospital.
A cross-sectional primary survey using a structured questionnaire administered through stratified random sampling. Data was collected from three major tertiary care hospitals in Faisalabad, Lahore, and Multan, Punjab, Pakistan. A binary logistic regression model was applied to analyze the data.
graph TD
A["Develop Structured Questionnaire"] --> B["Collect Data via Stratified Random Sampling"];
B --> C["Data Entry and Cleaning"];
C --> D["Apply Binary Logistic Regression Model"];
D --> E["Analyze Results"];
E --> F["Draw Conclusions and Policy Implications"];
The study highlights that patients bypass closer hospitals due to perceived better facilities at tertiary care centers. Factors like the severity of illness, the need for specialized care, and the perceived quality of services at tertiary hospitals outweigh the convenience of proximity. The findings suggest that improvements in primary and secondary healthcare facilities are crucial to reduce bypassing.
Several independent variables, including gender, age, income, marital status, problem of inequality, severity of disease, availability of ambulance, availability of own transport facility, recommendation from a friend, and referral from a primary health care unit, showed a positive and significant relationship with the patient's decision to bypass the closest hospital. Residential area, competency of doctor, and reputation of hospital had an inverse relationship with bypassing.
Patients in Punjab, Pakistan, bypass the closest hospitals due to a combination of demographic and behavioral factors, with a strong preference for perceived higher quality services at tertiary care facilities. Enhancing the quality and accessibility of primary and secondary healthcare is recommended to mitigate this issue and ensure equitable access to healthcare.
1. Pakistan is the 5th most populous country. (Confirmed by general knowledge).
2. Data was collected from three major tertiary care hospitals in Faisalabad, Lahore, and Multan. (Confirmed in the text).
3. A total of 600 patients were selected for the study. (Confirmed in the text).
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