Inter-regional patient outmigration to Seoul in South Korea: the role of regional healthcare quality perceptions.

Abstract

Background: Public perception of healthcare quality reflects a people-centered approach to evaluating quality and influences healthcare utilization. Patient choice of healthcare providers is not solely based on objective measures, but varies with perceived quality factors such as experiences and trust. In South Korea, a large number of patients with severe diseases bypass their regional tertiary hospitals and receive treatment from a few tertiary hospitals located in the capital city Seoul: that is, they outmigrate. In this paper, we aimed to directly measure the public's feeling of reassurance with their regional healthcare system and examine it in explaining patient outmigration in South Korea.

Methods: The data of this study came from an online survey involving 1,241 individuals that was conducted in 2020 - 2021 to investigate healthcare-related perceptions of the public. Using stated preference data on hypothetical vignettes involving a cancer diagnosis, we measured outmigration and feeling of reassurance. We performed a logistic regression to assess the association between the two variables, controlling for tertiary hospital beds, distance to Seoul, and sociodemographic characteristics.

Results: Among 581 respondents, 65.6% reported that there is a regional hospital they felt reassured to visit when diagnosed with cancer, while 63.5% were inclined towards outmigration to Seoul when they need surgery for lung cancer. There was a clear and robust negative association between outmigration and feeling of reassurance, where individuals who felt reassured with their regional healthcare system were 18.6% points less likely to outmigrate to Seoul.

Conclusions: Individuals' feeling of reassurance with the regional healthcare system plays a crucial role in outmigration in South Korea. These results emphasize the need to consider patients' subjective perception of quality in analyzing patients' decision-making and hospital choice. Policy efforts to alleviate the concentration of patients into Seoul should consider how the public perceives and interprets the regional-level quality of care.