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

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.