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Med Care Res Rev. 2017 Aug;74(4):379-403. doi: 10.1177/1077558716654631. Epub 2016 Jun 28.

Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review.

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1 London School of Hygiene and Tropical Medicine, London, UK.
2 Cardiff University, Cardiff, UK.
3 King's College London, London, UK.


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.


hospital bypassing; patient choice; patient mobility; provider competition

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