Likelihood Of Bypass Research Articles

Privilege and Place: an exploratory study about healthcare bypass behavior.

Bypass, or utilizing healthcare outside of one's community rather than local health care, can have serious consequences on rural healthcare availability, quality, and outcomes. Previous studies of the likelihood of healthcare bypass used various individual and community characteristics. This study includes measures for individuals and communities, as well as place-based characteristics. The authors introduce the Social Vulnerability of Place Index (SoVI) - a well-established measure in disaster literature - into healthcare studies to further explain the impact of place on healthcare selection behavior. Additionally, with the use of open-ended questions, this study explains why people choose to bypass. By including each of these measures, this study provides a more nuanced and detailed understanding of how individual healthcare selection is affected by the privilege of the individual, community ties, place of residence, and primary motivator for bypass. A systematic random sample of residents from 25 rural towns in the western US state of Utah were surveyed in 2017 in the Rural Utah Community Survey. After accounting for missing data, the total sample size was 1061. This study used logistic regression to better predict the likelihood of rural healthcare bypass behavior. Measures associated with community push factors (dissatisfaction with various local amenities), community pull factors (friends in community and length of residence), individual ability (demographics, self-reported health, and distance to a hospital), and SoVI, were added to the models to examine their impact on the likelihood of bypass. The SoVI was made using census data with variables that measure both social and place inequality. Each town in the study received a SoVI score and was then categorized as having low, mean, or high social vulnerability. Qualitative open-ended responses about healthcare selection were coded for explanations given for bypassing. The pooled model showed that bypass was more likely amongst residents who were dissatisfied with local health care and more likely for females. Breaking bypass down, according to SoVI, provides a more nuanced understanding of bypass. For people living in low socially vulnerable areas, privileges such as graduating college made them more likely to bypass. For high socially vulnerable areas, privilege did not help people bypass, but disadvantages such as aging made residents less likely to bypass. Thus, by introducing the SoVI into healthcare literature, this study can compare healthcare selection behaviors of residents in low vulnerable towns, average vulnerable towns, and highly vulnerable towns. Additionally, the analysis of open-ended responses showed patterns explaining why people bypass. Policymakers and public health workers can use the SoVI to better target their healthcare outreach. Reasons for bypass include quality, selection, consistency, cost of insurance, one-stop shop, and confidentiality. Rural clinics can help residents avoid the need to bypass by improving in these areas and thus gaining patients and minimizing the risk of closure. Healthcare policymakers should focus resources on high socially vulnerable places as well as underprivileged people in low socially vulnerable places.

Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan

BackgroundA common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system.MethodsThis repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass.ResultsThe standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities.ConclusionsAlthough the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass.