IDEAS home Printed from https://ideas.repec.org/a/eee/jotrge/v110y2023ics0966692323000807.html
   My bibliography  Save this article

Understanding patients heterogeneity in healthcare travel and hospital choice - A latent class analysis with covariates

Author

Listed:
  • Gao, Ya
  • Pan, Haixiao
  • Xie, Zhilin
  • Habib, Khandker Nurul

Abstract

Access to health care is key to well-being, and it is increasingly clear that aggregated accessibility analysis is hard to reflect people's actual healthcare behaviour. This paper employs a patient-based healthcare travel survey to obtain a nuanced picture of how healthcare travel varies across patients. The existing literature shows transportation is an essential factor in accessing health care; however, most studies focus on separate healthcare travel mode choices or hospital choices for certain segments of patients, making it difficult to derive clear profiles of patients. Also, the attitudinal factors in healthcare travel have long been neglected. This research explores the joint hospital choice and travel behaviour of patients. We conducted an online survey with patients in Shanghai to identify the heterogeneity in healthcare travel behaviour and hospital choice. A latent class model with covariates is adopted to identify different patient types that exhibited distinct hospital choices and healthcare travel behaviour. Attitudinal factors are included in our model to form clear-separated clusters. Four categories of patients are identified: public transit patients, car-oriented patients, near-hospital patients, and non-downtown hospital patients, which differ in sociodemographic characteristics, healthcare-seeking behaviour, and public transit accessibility. Our research shows that a substantial share of non-downtown hospital patients should not be underestimated in healthcare travel demand analysis. The behaviour of public transit and non-downtown patients requires improvement of quality and public transit accessibility in non-downtown tertiary hospitals. Our study contributes to a better understanding of the market segments of patients and tailored healthcare and transport policies to meet patient healthcare travel demand.

Suggested Citation

  • Gao, Ya & Pan, Haixiao & Xie, Zhilin & Habib, Khandker Nurul, 2023. "Understanding patients heterogeneity in healthcare travel and hospital choice - A latent class analysis with covariates," Journal of Transport Geography, Elsevier, vol. 110(C).
    • Handle: RePEc:eee:jotrge:v:110:y:2023:i:c:s0966692323000807
    DOI: 10.1016/j.jtrangeo.2023.103608
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0966692323000807
    Download Restriction: no
    File URL: https://libkey.io/10.1016/j.jtrangeo.2023.103608?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Jin, Tanhua & Cheng, Long & Wang, Kailai & Cao, Jun & Huang, Haosheng & Witlox, Frank, 2022. "Examining equity in accessibility to multi-tier healthcare services across different income households using estimated travel time," Transport Policy, Elsevier, vol. 121(C), pages 1-13.
    2. Rafiq, Rezwana & McNally, Michael G., 2021. "Heterogeneity in Activity-travel Patterns of Public Transit Users: An Application of Latent Class Analysis," Transportation Research Part A: Policy and Practice, Elsevier, vol. 152(C), pages 1-18.
    3. Sharma, Gajanand & Patil, Gopal R., 2021. "Public transit accessibility approach to understand the equity for public healthcare services: A case study of Greater Mumbai," Journal of Transport Geography, Elsevier, vol. 94(C).
    4. Honora Smith & Christine Currie & Pornpimol Chaiwuttisak & Andreas Kyprianou, 2018. "Patient choice modelling: how do patients choose their hospitals?," Health Care Management Science, Springer, vol. 21(2), pages 259-268, June.
    5. Le Luo & Yuxuan Zhang & Yumeng Zhang & Chenchen Feng & Xinli Zhang, 2022. "Large hospitals' outpatient diversion system in China: Following individual intention and referral," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(4), pages 1973-1989, July.
    6. Vermunt, Jeroen K., 2010. "Latent Class Modeling with Covariates: Two Improved Three-Step Approaches," Political Analysis, Cambridge University Press, vol. 18(4), pages 450-469.
    7. Gilles Celeux & Gilda Soromenho, 1996. "An entropy criterion for assessing the number of clusters in a mixture model," Journal of Classification, Springer;The Classification Society, vol. 13(2), pages 195-212, September.
    8. Molin, Eric & Mokhtarian, Patricia & Kroesen, Maarten, 2016. "Multimodal travel groups and attitudes: A latent class cluster analysis of Dutch travelers," Transportation Research Part A: Policy and Practice, Elsevier, vol. 83(C), pages 14-29.
    9. Cao, Wen-Rui & Huang, Qiu-Ru & Zhang, Nan & Liang, Hui-Juan & Xian, Ben-Song & Gan, Xiao-Fang & Xu, Dong Roman & Lai, Ying-Si, 2022. "Mapping the travel modes and acceptable travel time to primary healthcare institutions: A case study in Inner Mongolia Autonomous Region, China," Journal of Transport Geography, Elsevier, vol. 102(C).
    10. Peter Sivey, 2012. "The effect of waiting time and distance on hospital choice for English cataract patients," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 444-456, April.
    11. Hjelmgren, Jonas & Anell, Anders, 2007. "Population preferences and choice of primary care models: A discrete choice experiment in Sweden," Health Policy, Elsevier, vol. 83(2-3), pages 314-322, October.
    12. Varkevisser, Marco & van der Geest, Stéphanie A. & Schut, Frederik T., 2012. "Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands," Journal of Health Economics, Elsevier, vol. 31(2), pages 371-378.
    13. Varotto, Silvia F. & Glerum, Aurélie & Stathopoulos, Amanda & Bierlaire, Michel & Longo, Giovanni, 2017. "Mitigating the impact of errors in travel time reporting on mode choice modelling," Journal of Transport Geography, Elsevier, vol. 62(C), pages 236-246.
    14. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    15. Du, Fangye & Mao, Liang & Wang, Jiaoe, 2021. "Determinants of travel mode choice for seeking healthcare: A comparison between elderly and non-elderly patients," Journal of Transport Geography, Elsevier, vol. 92(C).
    16. Demitiry, Maria & Higgins, Christopher D. & Páez, Antonio & Miller, Eric J., 2022. "Accessibility to primary care physicians: Comparing floating catchments with a utility-based approach," Journal of Transport Geography, Elsevier, vol. 101(C).
    17. Kanuganti, Shalini & Sarkar, Ashoke Kumar & Singh, Ajit Pratap, 2016. "Evaluation of access to health care in rural areas using enhanced two-step floating catchment area (E2SFCA) method," Journal of Transport Geography, Elsevier, vol. 56(C), pages 45-52.
    18. Linzer, Drew A. & Lewis, Jeffrey B., 2011. "poLCA: An R Package for Polytomous Variable Latent Class Analysis," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 42(i10).
    19. Ardeshiri, Ali & Vij, Akshay, 2019. "Lifestyles, residential location, and transport mode use: A hierarchical latent class choice model," Transportation Research Part A: Policy and Practice, Elsevier, vol. 126(C), pages 342-359.
    20. Neutens, Tijs, 2015. "Accessibility, equity and health care: review and research directions for transport geographers," Journal of Transport Geography, Elsevier, vol. 43(C), pages 14-27.
    21. Shah, Harsh & Carrel, Andre L. & Le, Huyen T.K., 2021. "What is your shopping travel style? Heterogeneity in US households’ online shopping and travel," Transportation Research Part A: Policy and Practice, Elsevier, vol. 153(C), pages 83-98.
    22. Tayyari Dehbarez, Nasrin & Gyrd-Hansen, Dorte & Uldbjerg, Niels & Søgaard, Rikke, 2018. "Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system," Health Policy, Elsevier, vol. 122(7), pages 722-727.
    23. Xuefeng Li & Yong Zhang & Mingyang Du, 2018. "Analysis of Travel Decision-Making for Urban Elderly Healthcare Activities under Temporal and Spatial Constraints," Sustainability, MDPI, vol. 10(5), pages 1-15, May.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kim, Sung Hoo & Mokhtarian, Patricia L., 2023. "Finite mixture (or latent class) modeling in transportation: Trends, usage, potential, and future directions," Transportation Research Part B: Methodological, Elsevier, vol. 172(C), pages 134-173.
    2. Elizabeth Weigensberg & Derekh Cornwell & Lindsey Leininger & Matthew Stagner & Sarah LeBarron & Jonathan Gellar & Sophie MacIntyre & Richard Chapman & Erin J. Maher & Peter J. Pecora & Kirk O’Brien, "undated". "Superutilization of Child Welfare, Medicaid, and Other Services," Mathematica Policy Research Reports caaff77fa722452aa241ace4b, Mathematica Policy Research.
    3. Fangye Du & Jiaoe Wang & Haitao Jin, 2021. "Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data," IJERPH, MDPI, vol. 18(15), pages 1-14, July.
    4. Daniel Avdic & Tugba Bueyuekdurmus & Giuseppe Moscelli & Adam Pilny & Ieva Sriubaite, 2018. "Subjective and objective quality reporting and choice of hospital: Evidence from maternal care services in Germany," CINCH Working Paper Series 1803, Universitaet Duisburg-Essen, Competent in Competition and Health.
    5. Li, Chuanyao & Wang, Junren, 2022. "A hierarchical two-step floating catchment area analysis for high-tier hospital accessibility in an urban agglomeration region," Journal of Transport Geography, Elsevier, vol. 102(C).
    6. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    7. Puck Beukers & Ron Kemp & Marco Varkevisser, 2014. "Patient hospital choice for hip replacement: empirical evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 927-936, December.
    8. Martini, Gianmaria & Levaggi, Rosella & Spinelli, Daniele, 2022. "Is there a bias in patient choices for hospital care? Evidence from three Italian regional health systems," Health Policy, Elsevier, vol. 126(7), pages 668-679.
    9. Rezwana Rafiq & Michael G. McNally, 2023. "An exploratory analysis of alternative travel behaviors of ride-hailing users," Transportation, Springer, vol. 50(2), pages 571-605, April.
    10. Mensen, Anne, 2022. "Concentration of hospital capacities and patients' access to care," Ruhr Economic Papers 952, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    11. Suzanne Ruwaard & Rudy Douven, 2014. "Quality and hospital choice for cataract treatments: the winner takes most," CPB Discussion Paper 272, CPB Netherlands Bureau for Economic Policy Analysis.
    12. Giuseppe Moscelli & Luigi Siciliani & Nils Gutacker & Hugh Gravelle, 2016. "Location, quality and choice of hospital: Evidence from England 2002/3 - 2012/13," Working Papers 123cherp, Centre for Health Economics, University of York.
    13. Ferré, Francesca & Seghieri, Chiara & Nuti, Sabina, 2023. "Women's choices of hospital for breast cancer surgery in Italy: Quality and equity implications," Health Policy, Elsevier, vol. 131(C).
    14. Olde Kalter, Marie-José & La Paix Puello, Lissy & Geurs, Karst T., 2020. "Do changes in travellers’ attitudes towards car use and ownership over time affect travel mode choice? A latent transition approach in the Netherlands," Transportation Research Part A: Policy and Practice, Elsevier, vol. 132(C), pages 1-17.
    15. Visa Pitkänen & Ismo Linnosmaa, 2021. "Choice, quality and patients’ experience: evidence from a Finnish physiotherapy service," International Journal of Health Economics and Management, Springer, vol. 21(2), pages 229-245, June.
    16. Schmid, Andreas & Varkevisser, Marco, 2016. "Hospital merger control in Germany, the Netherlands and England: Experiences and challenges," Health Policy, Elsevier, vol. 120(1), pages 16-25.
    17. Suzanne Ruwaard & Rudy Douven, 2014. "Quality and hospital choice for cataract treatments: the winner takes most," CPB Discussion Paper 272.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    18. Paul Dolan & Kate Laffan & Alina Velias, 2022. "Who’s miserable now? Identifying clusters of people with the lowest subjective wellbeing in the UK," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 58(4), pages 679-710, May.
    19. Ewa Genge & Francesco Bartolucci, 2022. "Are attitudes toward immigration changing in Europe? An analysis based on latent class IRT models," Advances in Data Analysis and Classification, Springer;German Classification Society - Gesellschaft für Klassifikation (GfKl);Japanese Classification Society (JCS);Classification and Data Analysis Group of the Italian Statistical Society (CLADAG);International Federation of Classification Societies (IFCS), vol. 16(2), pages 235-271, June.
    20. Jinhui Ma & Haijing Huang & Daibin Liu, 2023. "Influences of Spatial Accessibility and Service Capacity on the Utilization of Elderly-Care Facilities: A Case Study of the Main Urban Area of Chongqing," IJERPH, MDPI, vol. 20(6), pages 1-19, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jotrge:v:110:y:2023:i:c:s0966692323000807. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: https://www.journals.elsevier.com/journal-of-transport-geography .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.