Determinants of Out-of-Region Healthcare Use and Patient Experiences in Brain Disorders in Gyeongsangnam-Do : An Andersen’s Behavioral Model Approach

초록

Objective : Healthcare utilization in South Korea is disproportionately concentrated in the capital area, raising substantial concerns about equity and system efficiency, particularly for patients with neurosurgical brain disorders residing outside the capital region. This study applied Andersen’s Behavioral Model to identify the determinants of out-of-region (capital-area) healthcare utilization. Methods : A cross-sectional survey was conducted (November 2023 to January 2024) among 363 adults aged ≥18 years attending neurosurgery outpatient clinics at one non-capital tertiary hospital (n=181) and one capital-area tertiary hospital (n=182). Structured questionnaires assessed predisposing (e.g., education, behaviors), enabling (e.g., income, caregiver location), and need factors (e.g., disease history). Multivariable logistic regression estimated associations with out-of-region utilization as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results : Out-of-region utilization was associated with education (middle/high school : aOR, 3.22; 95% CI, 1.20–8.67; college or higher : aOR, 3.27; 95% CI, 1.04–10.29), regular health checkups (aOR, 3.28; 95% CI, 1.23–8.79), caregiver outside region (aOR, 6.05; 95% CI, 2.47–14.85), higher monthly household income (3–5 million Korean Won [KRW] : aOR, 7.06; 95% CI, 3.28–15.22; over 5 million KRW : aOR, 17.52; 95% CI, 7.3–42.06), no cerebrovascular disease history (aOR, 0.18; 95% CI, 0.08–0.41), and prior brain surgery/procedure (aOR, 2.71; 95% CI, 1.31–5.62). The model explained 57.8% of the variance. Conclusion : Guided by Andersen’s model, tailored interventions addressing predisposing, enabling, and need-related factors are needed to reduce potentially avoidable capital-region utilization among patients with brain disorders in Gyeongsangnam-do and improve regional equity. Further multicenter longitudinal studies should validate causality and intervention efficacy.

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