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1 1393/3/10 : 1392/5/18 : 1393 /3 / :.. : 21. ICD10. 6 Eviews 40 :... :. :.(1) hossien.ghaderi@yahoo.com : :. : 1393 / 3 / 3 256
2 . (5). - Buor..(7).(7 8).(4 9).(10)..(2).(3).(4).(5).(6) 257
3 .(15)..(16) (3 4 17).(18).(4 19)..(11).(12).(13).(14) 258
4 : ) ( ) (ICD10..( ). (21). (Logit)
5 .. ) (... Hosmer- Lemeshow test ICD10 21 ICD10.. :(1) Y = α 0 dis ij + α 1 (bed i / bed j ) + α 3 (dr i / dr j ) + α 4 sex + α 5 age + α 6 dtam + α 7 dkh + e ijt Y dis ij. j i 1000 bed dr j i sex age dkh dtam ( Dummy Variable) 260
6 Davidson and MacKinnon ) 9 ( )15 )18 ( ( ( ) 5. ( ) Eviews ICD10 :1 I 2/ VIII 0/ XV 12/ II 7/ IX 12/ XVI 2/ III 2/ X 6/ XVII 2/ IV 2/ XI 5/ XVIII 11/ V 0/13 60 XII 0/ XIX 4/ VI 2/ XIII 1/ XX 0/00 0 VII 5/ XIV 10/ XXI 8/
7 8/90 0/39 1/90 0/98 0/84 9/28 1/ : /24 10/44 20/81 18/10 2/67 7/36 1/20 7/ ICD ( ) 7. :(2) Mig total= 0/002dis -1/38dr- 0/91bed +0/0001age +0/007sex +0/1 dtam+0/05dkh (-18/11) (-19/22) (-46/07) (1/84) (2/38) (15/57) (7/99).. 262
8 z 21 :4 + 0/ / 08 1/ 62 0/ 003-2/ 4 Mig ICD1 0/ 05 (- 2/03) + 0/ 04 (2/97) + 0/ 19 (3/03) 0/ 005 (-5/29) 0/ 008 (- 3/82) 003 (- 5/16) - 0/ 01 -( 6/02) 0/ 001 (- 3/69) + 0/ 0008 (2/83) - 0/ 004 (- 2/58) + 0/ 002-1/01 (-12/48) 61 (-10/37) 75 (-11/2) -1/76 (-4/15) -1/34 (3/31) 0/12 (1/80) + 0/ 47 (2/68) + 0/ 097 (2/8) + 0/ 05 (2/37) + 0/ 09 (4/09) + 0/ 032 (1/61) + 0/ 13 (3/06) 0/24 (3/4) + 0/ 33 (4/40) + 0/ 57 (3/15) + 0/ 011 (2/99) + 0/ 07 (2/48) + 0/ 12 (5/36) + 0/ 06 (2/72) + 0/ 05 (2/35) + 0/ 05 (2/42) +0/25 (3/58) + 0/ 19 (- 6/37) -2/ 03 (-3/76) 3/ 74 (- 2/79) 2/ 61 (- 3/46) 2/ 88 (- 5/39) 8/ 4 (- 5/17) -2/01 (-6/33) 93 (-5/37) -1/03 (-4/76) -2/91 (- 6/62) 0/ 0035 (-4/36) 008 (-3/16) 0/ 0056 (- 3/87) 006 (- 5/34) 017 (- 5/18) 003 (-6/19) 001 (-4/64) 001 (-4/4) 01 (- 3/72) 004 (-3/78) 2/47 (4/02) 4/13 (2/96) 2/23 (2/91) 2/87 (4/95) 9/17 (5/16) -2/ 8 (7/09) 1/21 (5/75) 1/44 (5/43) 12 (- 8/76) 1/01 (3/46) -3/ 84 Mig ICD 2 Mig ICD 3 Mig ICD4 Mig ICD 6 Mig ICD 7 Mig ICD8 Mig ICD 9 Mig ICD 10 Mig ICD11 Mig ICD 12 Mig ICD13 Mig ICD 14 (4/18) (-9/7) (3/74) (5/19) (-4/85) (-4/8) (5/14) / / / /62 Mig ICD 15 (-4/26) (2/23) (-20/25) (1/97) (2/67) (-6/86) (6/53) (8/77) + 0/ / /94 Mig ICD16 (2/6) (3/15) (-6/18) (-8/19) (5/56) / / 46-3/ /24 Mig ICD17 (- 3/46) (3/08) (2/39) (-1/91) (-2/16) (1/85) / / 17-2/ /84 Mig ICD18 (- 3/46) (2/95) (6/42) (-12/2) (- 12/42) (11/32) + 0/ / /58 Mig ICD19 (3/30) (-15/21) (4/78) (-5/22) (-5/24) (6/59) + 0/ /45 + 0/ / 29-1/ /22 Mig ICD 21 (2/62) (- 5/77) (3/92) (3/03) (6/07) (-2/57) (- 9/08) (3/91) 263
9 .. Roh.(16).. Lee Roh.(16).... Nante Levaggi Baker (1 6 18) (21).. 264
10 ) ( DRG (Diagnosis Related Groups)
11 ... References 1. Nante N, Ricciardi G, Al Farraj O, Morgagni S, Siliquini R, Moirano F, et al. Hospital patient migration:analysis using an utility index. Public Health in Europe 2003; Goodridge D, Hawranik P, Duncan V, Turner H. Socioeconomic disparities in home health care service access and utilization: a scoping review.int J Nurs Stud Oct;49(10): Chernew M, Scanlon D, Hayward R. Insurance type and choice of hospital for coronary artery bypass graft surgery.health Serv Res Aug;33(3 Pt 1): Hodgkin D. Specialized service offerings and patients' choice of hospital: the case of cardiac catheterization.j Health Econ Jun;15(3): Ricketts TC, Randolph R, Howard HA, Pathman D, Carey T.Hospitalization rates as indicators of access to primary care.health Place Mar;7(1): Baker JB. Examining spatial patterns of primary health care utilization in southern Honduras. United States - Ohio: Cincinnati; Buor D. Distance as a predominant factor in the utilisation of health services in the Kumasi metropolis, Ghana. Geo J. 2002;56(2): Stock R.Distance and the utilization of health facilities in rural Nigeria. Soc Sci Med. 1983;17(9): ICD Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States.Milbank Mem Fund Q Health Soc. 1973;51(1): Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care Feb;19(2): Mooney G, Hall J, Donaldson C, Gerard K.Utilisation as a measure of equity: weighing heat?j Health Econ. 1991;10(4): Bailey W, Phillips DR. Spatial patterns of use of health services in the Kingston metropolitan area, Jamaica.Soc Sci Med. 1990;30(1): Muller I, Smith T, Mellor S, Rare L, Genton B. The effect of distance from home on attendance at a small rural health centre in Papua New Guinea. Int J Epidemiol Oct;27(5): Messina G, Vigiani N, Lispi L, Nante N. Patient migration among the Italian regions in Italian Journal of Public Health. 2008;5(1): Roh CY, Lee KH. Hospital choice by rural medicare beneficiaries: does hospital ownership matter?--a Colorado case. J Health Hum Serv Adm. 2006;28(3): Fabbri D, Robone S. The geography of hospital admission in a national health service with patient choice. Health Econ Sep;19(9): Egunjobi L. Factors influencing choice of hospitals: a case study of the northern part of Oyo State, Nigeria. Soc Sci Med. 1983;17(9):
12 18. Levaggi R, Zanola R. Patients' migration across regions: the case of Italy. Applied Economics. 2004;36(16): Rozenberg S, Ham H. Effect of physicians opinion on patients' choice of treatment. Eur JObstet Gynecol Reprod Biol Jun;96(2): Burns LR, Wholey DR. The impact of physician characteristics in conditional choice models for hospital care.j Health Econ May;11(1): Saber Mahani A, Hadian M, Ghaderi H, Barouni M, Shakibaei A, Bahrami MA. Comparing the efficiency of Kerman province towns in acquiring human development index via data envelopment analysis. Iran Red Crescent Med J Apr;14(4): / 3 / 3
13 Journal of Health & Development Original Article Vol. 3, No. 3, Autumn 2014 Received: Accepted: Factors Related to Patient Migration in Kerman Province Asma Sabermahani 1, Hamid Reza Ashrafzadeh 2, Farid Abolhasani 3, Mohsen Barouni 4, 5 Hosein Ghaderi Abstract Background: Awareness toward peoples utilization of health care facilities is a very important issue in the programming and resource allocation process. With implementation of family physician project in Iran and attempts for reforming health referral system, patients mobility between regions and its related factors have found more importance. Methods: In this research by using the logit economic model and through retrospective design, the relationship of patient migration with patients demographic features, type of health insurance, distance from the health care center and hospitals features was determined in 21 disease groups, based on the final diagnosis recorded in patients medical files and ICD10 codes. Eviews 6 software was used for all estimations. Results: About 40 percent of inpatients in Kerman hospitals had migrated from other cities where the same services had been available, but the patients were not satisfied of the quality of them. Negative effects of geographical distance, physician and hospital bed count and the positive effect of insurances were constant in all groups, showing similar effects of these variables on patient migration in all disease groups. Conclusion: Results show that factors like distance and kind of disease have no more effect on patient migration than patient perception of the health care center; and ignoring this item, especially in planning the referral system in the big project of family physician, can result in problems in relation to patient equity, patient satisfaction and health organizations financial support. Keywords: Patient migration, Logit model, Kerman Province 1- Assistant Professor, Research Center for Modeling in Health, Institute of Futures Studiesin Health, Kerman University of Medical Sciences, Kerman, Iran 2- Associate Professor, Institute for Trade Studies and Research, Tehran, Iran 3- Associate Professor, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran 4- Assistant Professor, Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 5- Assistanat Professor, Departments of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Corresponding Author: Dr Hossien Ghaderi hossien.ghaderi@yahoo.com Address: School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Tel/Fax:
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