Determinants of Patient’s Choice to Bypass the Closest Hospital: A Case Study of Punjab, Pakistan

Abstract

Pakistan is a developing, 5^th populous country with recession in economic indicators. Bypassing is the phenomenon that is widely discussed among the low income countries due to the less provision of health care facilities at primary health care centers. Secondary healthcare centers provide specialized level of diagnostic and treatment facilities while tertiary care hospitals provide specialized healthcare facilities at advance level. There is an impression of better health service facilities at tertiary care hospitals as compared to primary and secondary healthcare hospitals located near the patient’s homes. So, they prefer to go to tertiary care hospitals after bypassing the closest secondary care hospitals. The objective of this study was to evaluate the factors that caused patients to bypass the closest hospital. A well-structured questionnaire was developed to collect data through a stratified random sampling technique. Data were collected from three major tertiary care hospitals of Faisalabad, Lahore, and Multan in Punjab province. The dependent variable was in dichotomous form so, binary logistic model was applied to see the effects of several independent variables such as patient’s demographic and behavioral factors that were consisted on problem of inequality, severity of disease, competency of doctor, reputation of hospital, availability of ambulance, availability of own transport facility, recommendation from friend, referred from primary health care. Results revealed that all these variables had a positive and significant relationship with the patient decision to bypass the closest hospital except residential area, competency of doctor and reputation of hospital. It is suggested that Government should take measures to upgrade the primary health care units to minimize the problem of bypassing the closest hospital. It will reduce the financial burden of patients that automatically enhance their well-being.