Background: Patient mobility can be defined as a patient's movement or utilization of a health care service located in a place or region other than the patient's place of residence. Mobility provides freedom to patients to obtain health care from providers across regions and even countries. It is essential to monitor patient choices in order to maintain the quality standards and responsiveness of the health system, otherwise, the health system may suffer from geographic disparities in the accessibility to quality and responsive health care. In this article, we study patient mobility in a national health care system to identify medical regions, spatio-temporal and service characteristics of health care utilization, and demands for patient mobility.
Methods: We conducted a systematic analysis of province-to-province patient mobility in Turkey from December 2009 to December 2013, which was derived from 1.2 billion health service records. We first used a flow-based regionalization method to discover functional medical regions from the patient mobility network. We compare the results of data-driven regions to designated regions of the government in order to identify the areas of mismatch between planned regional service delivery and the observed utilization in the form of patient flows. Second, we used feature selection, and multivariate flow clustering to identify spatio-temporal characteristics and health care needs of patients on the move.
Results: Medical regions we derived by analyzing the patient mobility data showed strong overlap with the designated regions of the Ministry of Health. We also identified a number of regions that the regional service utilization did not match the planned service delivery. Overall, our spatio-temporal and multivariate analysis of regional and long-distance patient flows revealed strong relationship with socio-demographic and cultural structure of the society and migration patterns. Also, patient flows exhibited seasonal patterns, and yearly trends which correlate with implemented policies throughout the period. We found that policies resulted in different outcomes across the country. We also identified characteristics of long-distance flows which could help inform policy-making by assessing the needs of patients in terms of medical specialization, service level and type.
Conclusions: Our approach helped identify (1) the mismatch between regional policy and practice in health care utilization (2) spatial, temporal, health service level characteristics and medical specialties that patients seek out by traveling longer distances. Our findings can help identify the imbalance between supply and demand, changes in mobility behaviors, and inform policy-making with insights.
Keywords: Flow mapping; Health care; Patient mobility; Regionalization; Spatial data mining.