Many countries have introduced policies that enable patients to select a health care provider of their choice with the aim of improving the quality of care. However, there is little information about the drivers or the impact of patient mobility. Using administrative hospital data (n = 19 256) we analysed the mobility of prostate cancer patients who had radical surgery in England between 2010 and 2014. Our analysis, using geographic information systems and multivariable choice modelling, found that 33·5% (n = 6465) of men bypassed their nearest prostate cancer surgical centre. Travel time had a strong impact on where patients moved to but was less of a factor for men who were younger, fitter, and more affluent (p always < 0.001). Men were more likely to move to hospitals that provided robotic prostate cancer surgery (odds ratio: 1.42, p < 0.001) and to hospitals that employed surgeons with a strong media reputation (odds ratio: 2.18, p < 0.001). Patient mobility occurred in the absence of validated measures of the quality of care, instead influenced by the adoption of robotic surgery and the reputation of individual clinicians. National policy based on patient choice and provider competition may have had a negative impact on equality of access, service capacity, and health system efficiency.

Patient summary

In this study, we assessed the reasons why men would choose to have prostate cancer surgery at a centre other than their nearest. We found that in England men were attracted to centres that carried out robotic surgery and employed surgeons with a national reputation.

中文翻译：

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前列腺癌手术患者活动能力的决定因素：基于人群的选择和竞争研究

许多国家已经出台政策，使患者能够选择自己选择的医疗保健提供者，以提高医疗质量。然而，关于驱动因素或患者流动性影响的信息很少。使用行政医院数据 ( n  = 19 256)，我们分析了 2010 年至 2014 年间在英格兰接受根治性手术的前列腺癌患者的流动性。我们使用地理信息系统和多变量选择模型的分析发现，33·5% ( n  = 6465) 的男性绕过了他们最近的前列腺癌手术中心。旅行时间对患者搬到哪里有很大影响，但对于更年轻、更健康和更​​富裕的男性来说，旅行时间的影响较小（p总是 < 0.001)。男性更有可能搬到提供机器人前列腺癌手术的医院（优势比：1.42，p  < 0.001）和雇佣具有良好媒体声誉的外科医生的医院（优势比：2.18，p  < 0.001）。患者流动性发生在缺乏经过验证的护理质量衡量标准的情况下，而是受到机器人手术的采用和个体临床医生声誉的影响。基于患者选择和提供者竞争的国家政策可能对获取平等、服务能力和卫生系统效率产生负面影响。

患者总结

在这项研究中，我们评估了男性选择在离他们最近的中心进行前列腺癌手术的原因。我们发现，在英格兰，男性被机器人手术中心所吸引，并聘请了具有全国声誉的外科医生。