title: Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review.
abstract: Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care provider. PubMed and Embase were searched for relevant articles between 1990 and 2015. Of 5,994 titles/abstracts reviewed, 26 studies were included. The studies used three main methodological models to establish mobility. Variation in the extent of patient mobility was observed across the studies. Mobility was positively associated with lower waiting times, indicators of better service quality, and access to advanced technology. It was negatively associated with advanced age or lower socioeconomic backgrounds. From a policy perspective we demonstrate that a significant proportion of patients are prepared to travel beyond their nearest provider for elective services. As a consequence, some providers are likely to be "winners" and others "losers," which could result in overall decreased provider capacity or inefficient utilization of existing services. Equity also remains a key concern.
authors.affiliation: 1 London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: 1 London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lewis
authors.affiliation: 2 Cardiff University, Cardiff, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mason
authors.affiliation: 3 King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
authors.affiliation: 1 London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
mesh_terms: D002755:Choice Behavior; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000592:standards*; D006291:Health Policy; D006296:Health Services / Q000600:supply & distribution*; D006801:Humans; D051346:Mobility Limitation; D011787:Quality of Health Care; D014850:Waiting Lists
keywords: hospital bypassing; patient choice; patient mobility; provider competition