Analysis of Self-Sufficiency and Factors Affecting Migration Between Medical Service Regions in Korea Among CKD Patients.

Background: Chronic kidney disease (CKD) represents a significant public health issue, characterized by high morbidity, mortality, and healthcare costs. The increasing global prevalence of CKD, attributed to aging populations and rising incidences of diabetes and hypertension, poses challenges affecting 8.2% of adults in Korea. Despite the presence of adequate local healthcare facilities, many patients seek medical care outside their region, leading to escalated costs and regional disparities. This study aims to understand why CKD patients, across various disease stages, opt to receive care outside their home regions and provides insights into improved healthcare resource management.

Methods: This study examined the inter-regional mobility patterns of 37,748 CKD patients in South Korea, utilizing National Health Insurance Service data from 2018 to 2022. Patients were categorized into three groups based on disease stage and treatment. The study assessed factors influencing healthcare service utilization, including individual factors, medical institution factors, and community factors. χ² tests and t-tests were applied, and multilevel logistic regression was employed for further analysis.

Results: The self-sufficiency rate, which is the percentage of cases where the treatment hospital is located in the patient's residential region, was notably high in metropolitan areas such as Seoul, Gyeonggi, and Incheon. Patients undergoing kidney transplantation exhibited the lowest self-sufficiency rates. Older patients and those with lower income tended to use local medical services regardless of the stage of CKD. Patients who visited tertiary hospitals at least once presented lower self-sufficiency rates, while facilities with fewer than 500 beds and community factors such as a lower proportion of elderly individuals and higher population densities were associated with higher self-sufficiency rates.

Conclusion: The movement of CKD patients across various healthcare regions is influenced by CKD characteristics, medical institution factors, and community factors. To enhance CKD patients' self-sufficiency, clear criteria for hospital selection, particularly for kidney transplants, are necessary, and healthcare policies should also take into account the diverse factors impacting self-sufficiency.