How should policy account of patient preferences when consolidating hospital services? The case of colon cancer surgery in Piedmont, Italy (with Andrew Street and Arianna Alfieri)

Abstract

As a result of regional policy, the number of hospitals performing colon cancer surgery in Piedmont fell from 65 in 2004 to 52 in 2014. During the same decade, the proportion of patients treated at the nearest hospital has fallen from 68% in 2004 to 62% in 2014.  Our objective is to understand the trade-off among distance and quality (measured in terms of waiting times and mortality) expressed by colon cancer patients in relation to the reconfiguration of cancer care services.  The study is based on the Hospital Discharge Data over the years 2004-2014, on a sample of more than 26000 patients.  We applied the conditional logit, which allows quantification of the impact of hospital-specific characteristics on patients’ probability of preferring one hospital over alternatives.

We analyse changes of preferences over time, suggesting a policy effect of concentrating services in more specialized facilities. Preliminary results confirm the negative impact of distance and positive impact of quality on patients’ choice. Waiting times act as quality variables only for older patients, whereas younger patients are responsive to mortality. Through time, distance is the only factor that shows a constantly increasing trend. By considering the context in which patients choose, such as changes in territorial configuration, we provide insights into how changes in policy could include consideration for patient preferences.

Biography

Elisabetta Listorti is a PhD candidate in Management, Production and Design at the Politecnico di Torino (Italy). She has a master degree in Management Engineering, and she has a master certificate in Health Economics and Policy. Her PhD focuses on the organization of volumes of activity among hospitals, by considering both policy makers' and patients' perspectives.