A Time-series Analysis of Hospital Choice Behavior of Inpatients

这项研究假设，住院患者的医院选择行为正在根据区域内提供的医疗服务水平、人口老龄化、与更好的生活水平相适应的日益高的医疗服务需求水平、交通便利等因素的组合而动态变化。然而，时间序列分析要求至少在同一地区进行两组医院选择调查。由于这一数据要求很少得到满足，过去关于医院选择行为的研究大多是静态的。相应地，广岛县1973年和1984年的医院选择调查数据的可用性促使了这项研究。对于每个调查数据，准备了住院患者的来源-目的地矩阵，并以最小信息损失为接近指标，通过聚类分析进行分析。在这两个日期之间，平均每天每1000人的患者日数从8.96天增加到10.78天，增加了1.82天。然而，这一增长的70%可以归因于人口老龄化因素。65岁及以上患者住处至医院平均距离由7.71公里适度缩短至7.53公里，至16岁患者由11.00公里缩短至9.17公里，15岁及以下患者由18.44公里缩短至15.92公里。然而，尽管各省的平均水平有所改善，偏远农村地区的数字却有所恶化。在该县人口减少的农村地区，为老年患者提供保健服务日益成为一个关键问题。

This study hypothesizes that the hospital choice behavior of impatients is dynamically changing from one time to another in accordance with a combination of factors such as the level of medical services provided in the region, aging of the population, increasingly higher level of demand for medical services commensurate with the better standard of living, ease of transportation and so on. The time-series analysis, however, requires at least two sets of hospital choice surveys taken in the same region. Because this data requirement has been rarely satisfied, past studies of hospital choice behavior have been mostly static.Accordingly, the data availability of hospital choice surveys in 1973 and 1984 in Hiroshima Prefecture has prompted this study. For each survey data, an origin-destination matrix of in- patients is prepared and analyzed by means of a cluster analysis based on the minimum information loss as the indicator of proximity. Between the two dates, the mean daily patient-days per 1000 population increased from 8.96 to 10.78, an increase of 1.82. Seventy percent of this gain, however, can be accounted for by the aging factor of population. Average distances between residences of patients and locations of hospitals had been moderately shortened from 7.71 km to 7.53 km among patients 65 years of age or older, from 11.00 km to 9.17 km among patients between 64 and 16 years of age, and from 18.44 km to 15.92 km among patients 15 years or younger. In spite of the improvements in the prefectural averages, however, figures for the remote rural areas had deteriorated. Health-care provision for aged patients in the depopulating rural areas of the Prefecture is increasingly becoming a critical issue.