| Determinants of Out-of-Region Healthcare Use and Patient Experiences in Brain Disorders in Gyeongsangnam-Do : An Andersen’s Behavioral Model Approach |
Kyeong-O Go1,2
, Kihwan Hwang3,4
, Jung Ho Han3,4
, Chae-Yong Kim3,4
, Sung-Hyo Seo5
, Mi-Ji Kim6,7
, Joo Hyun Sung7,8,9
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1Department of Neurosurgery, College of Medicine, Gyeongsang National University, Jinju, Korea
2Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
3Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea
4Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
5Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
6Department of Preventive Medicine, Institute of Medical Science, College of Medicine, Gyeongsang National University, Jinju, Korea
7Environmental Health Center for Gyeongsangnam-do, Gyeongsang National University, Jinju, Korea
8Department of Occupational and Environmental Medicine, Institute of Medical Science, College of Medicine, Gyeongsang National University, Jinju, Korea
9Department of Occupational and Environmental Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea |
| Correspondence |
Mi-Ji Kim ,Tel: +82-55-772-8091, Fax: +82-55-772-8099, Email: mijikim@gnu.ac.kr
Joo Hyun Sung ,Tel: +82-55-214-2050, Fax: +82-55-214-2059, Email: yadaf@gnu.ac.kr
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Received: April 23, 2026; Revised: June 21, 2026 Accepted: June 30, 2026. Published online: July 10, 2026.
*Kyeong-O Go and Kihwan Hwang contributed equally to this work. |
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| ABSTRACT |
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-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 income (3–5 million 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. |
| Key Words:
Brain diseases · Health services accessibility · Patient acceptance of health care · Choice behavior · Surveys and questionnaires |
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