Impact of patient choice and hospital competition on patient outcomes after rectal cancer surgery: A national population‐based study

Han, Lu; Boyle, Jemma M.; Walker, Kate; Kuryba, Angela; Braun, Michael; Fearnhead, Nicola; Jayne, David; Sullivan, Richard; Meulen, Jan van der; Aggarwal, Ajay

doi:10.1002/cncr.34504

Cited by 7 publications

(4 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The UK's integrated data science systems offer huge potential for health services research 140 . For example, we still have limited understanding of how best to organize our services 57,141,142 . We must understand the implication of different service models on travel burden, equity in access, outcomes and efficiency 143,144 .…”

Section: Services and Systemsmentioning

confidence: 99%

The future of cancer care in the UK—time for a radical and sustainable National Cancer Plan

Aggarwal,

Choudhury,

Fearnhead

et al. 2024

The Lancet Oncology

Self Cite

View full text Add to dashboard Cite

Section: Services and Systemsmentioning

confidence: 99%

The future of cancer care in the UK—time for a radical and sustainable National Cancer Plan

Aggarwal,

Choudhury,

Fearnhead

et al. 2024

The Lancet Oncology

Self Cite

View full text Add to dashboard Cite

“…It is important to improve this disconnect between perceived and actual cancer treatment quality because, otherwise, it has the potential create perverse incentives (e.g., technology adoption) without necessarily affecting patient outcomes 41 . Conversely, with adequate incentives, patient choice and hospital competition could support improved outcomes of care 42 …”

Section: Discussionmentioning

confidence: 99%

“…41 Conversely, with adequate incentives, patient choice and hospital competition could support improved outcomes of care. 42 Several recent studies have highlighted that patients wish to have information on the quality of breast cancer care at the hospitals in their region and that this information should be available at the start of the management pathway when a diagnosis is sought. [43][44][45] However, currently, a lot of this information comes through media channels, and it is widely recognized that the quality and validity of this information is often questionable.…”

Section: Determinants Of Treatment Locationmentioning

confidence: 99%

Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population‐based study

Aggarwal,

Han,

Lewis

et al. 2024

Cancer

Self Cite

View full text Add to dashboard Cite

BackgroundThis national study investigated hospital quality and patient factors associated with treatment location for breast cancer surgery.MethodsBy using linked administrative data sets from the English National Health Service, the authors identified all women diagnosed between January 2, 2016, and December 31, 2018, who underwent breast‐conserving surgery (BCS) or a mastectomy with or without immediate breast reconstruction. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regressions were used to estimate the impact of travel time, hospital quality, and patient characteristics.Results22,622 Of 69,153 patients undergoing BCS, 22,622 (32.7%) bypassed their nearest hospital; and, of 23,536 patients undergoing mastectomy, 7179 (30.5%) bypassed their nearest hospital. Women who were younger, without comorbidities, or from rural areas were more likely to travel to more distant hospitals (p < .05). Patients undergoing BCS (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.36–2.50) or mastectomy (OR, 1.52; 95% CI, 1.14–2.02) were more likely to be treated at specialist breast reconstruction centers despite not undergoing the procedure. Patients receiving mastectomy and immediate breast reconstruction were more likely to travel to hospitals employing surgeons who had a media reputation (OR, 2.41; 95% CI, 1.28–4.52). Patients undergoing BCS were less likely to travel to hospitals with shorter surgical waiting times (OR, 0.65; 95% CI, 0.46–0.92). The authors did not observe a significant impact for research activity, hospital quality rating, breast re‐excision rates, or the status as a multidisciplinary cancer center.ConclusionsPatient choice policies may drive inequalities in the health care system without improving patient outcomes.

show abstract

“…The parameters were set based on prior research hypotheses and relevant research. Following the assumptions of

and

0

, the values for patient medical cost coefficients were based on the research of Fu ( 51 ), Han ( 52 ), and Shang ( 53 ), leading to

7

2

, and

6

. Cost coefficients

0.5,

1

, and

4

referring to Xie ( 26 ) and Li ( 54 ) were based on the assumptions

and

0

.…”

Section: Numerical Simulationsmentioning

confidence: 99%

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

Zhao,

Li,

Zhang

2024

Front. Public Health

View full text Add to dashboard Cite

BackgroundCross-regional settlement management is a key indicator of national health insurance system maturity. Given the significant demand for cross-regional medical treatment among Chinese patients with malignant tumors and the territorially managed health insurance system, further research is necessary to explore the relationship between hospital settlement methods and treatment-seeking behaviors among these patients. This study introduces and validates an evolutionary game model that provides a theoretical foundation for direct settlement policies in cross-regional treatment.MethodsAn evolutionary game model was constructed with patients and hospitals serving as strategic players within a dynamic system. This model integrates the patients’ treatment utility, medical and nonmedical costs, and hospitals’ financial and technological advancement benefits.ResultsThe evolutionary stability analysis revealed seven-game outcomes between hospitals and patients with malignant tumors. The numerical simulations suggest an evolutionary convergence toward strategy (1, 0), indicating a trend where patients with malignant tumors opt for cross-regional treatment, yet hospitals choose not to implement a direct settlement policy. Parameter sensitivity analysis showed that the parameters set in this study affected player behavioral choices and game equilibria.ConclusionA strong demand for cross-regional medical treatment among Chinese patients with malignant tumors, and some hospitals require more incentives to implement cross-regional settlements. The key factors influencing the willingness of some patients with malignant tumors to resettle include the costs of in-area medical care, costs of cross-regional treatment without direct settlement, and the utility of cross-regional treatment. Technological advancement benefits and input costs influence some hospitals’ motivation to adopt cross-regional settlements. Policy adjustments that effectively implement direct settlement policies can facilitate equilibrium, enhance the initiatives of some local health insurance management departments, improve the accessibility and efficiency of medical services, and reduce nonmedical expenses for patients.

show abstract

Impact of patient choice and hospital competition on patient outcomes after rectal cancer surgery: A national population‐based study

Abstract: Background:The objective of the current national cohort study was to analyze the correlation between choice and competition on outcomes after cancer surgery in rectal cancer. Methods:The analysis included all men who underwent rectal cancer surgery in the

Cited by 7 publications

References 49 publications

The future of cancer care in the UK—time for a radical and sustainable National Cancer Plan

The future of cancer care in the UK—time for a radical and sustainable National Cancer Plan

Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population‐based study

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

Contact Info

Product

Resources

About