Analysing referral patterns to rural provincial hospitals

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

In Papua New Guinea a 3-tiered health care referral system has been functioning for several decades. Enga, a typical province, has 108 outpatient aid posts, each staffed by a primary health worker serving 1500 villagers. 10-20% of aid post patients are referred to the nearest rural health center, serving their districts of 30,000. Of health center patients, 10-20% are referred to the provincial hospital in the Wapenamanda district. The purpose of this study is to test the assumption that the provincial hospital is acting uniformly in its referral function for the 5 health center districts. A 2nd purpose is to find a simple way to estimate the number of admissions which derive from the hospital's potential aid post and health center functions for those who live nearest to it. Provincial hospital admissions were analyzed for the 1-year period 10/77-9/78, according to patient's clan and stated district of residence. After computing admission rates by district per 1000 population, these were plotted against distance from the hospital by the only passable roads. The effect of proximity is clearly demonstrated by the 298 (11.8%) local clan admissions; based on the provincial average of 15.9/1000, 29 local clan admissions would be expected there are 1848 local clans. Rates from the other 5 districts are only 20-60% of this rate. On the other hand, if it is assumed that in 5/6 of these local admissions, the hospital was in fact serving as the health center level, then the expected rate of hospital admission for the local province is 9.3 per 1000. Based on this rate, admissions from the other 5 districts are 40-90% of the expected rate. The advantage to local patients cannot be denied, in that health center level admissions receive provincial hospital level care. This simple analysis can be carried out in the health care system of any area. For political and logistical reasons, it may not be possible to eliminate health care differentials based on distance. However, this approach provides an internally consistent method of quantifying those differentials as a 1st step toward reducing them.

Original languageEnglish (US)
Pages (from-to)95-97
Number of pages3
JournalTropical Doctor
Volume15
Issue number2
StatePublished - 1985

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Rural Hospitals
Referral and Consultation
Health
Delivery of Health Care
Health Status
Rural Health Services
Papua New Guinea
Outpatients

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Analysing referral patterns to rural provincial hospitals. / Pust, Ronald E.

In: Tropical Doctor, Vol. 15, No. 2, 1985, p. 95-97.

Research output: Contribution to journalArticle

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abstract = "In Papua New Guinea a 3-tiered health care referral system has been functioning for several decades. Enga, a typical province, has 108 outpatient aid posts, each staffed by a primary health worker serving 1500 villagers. 10-20{\%} of aid post patients are referred to the nearest rural health center, serving their districts of 30,000. Of health center patients, 10-20{\%} are referred to the provincial hospital in the Wapenamanda district. The purpose of this study is to test the assumption that the provincial hospital is acting uniformly in its referral function for the 5 health center districts. A 2nd purpose is to find a simple way to estimate the number of admissions which derive from the hospital's potential aid post and health center functions for those who live nearest to it. Provincial hospital admissions were analyzed for the 1-year period 10/77-9/78, according to patient's clan and stated district of residence. After computing admission rates by district per 1000 population, these were plotted against distance from the hospital by the only passable roads. The effect of proximity is clearly demonstrated by the 298 (11.8{\%}) local clan admissions; based on the provincial average of 15.9/1000, 29 local clan admissions would be expected there are 1848 local clans. Rates from the other 5 districts are only 20-60{\%} of this rate. On the other hand, if it is assumed that in 5/6 of these local admissions, the hospital was in fact serving as the health center level, then the expected rate of hospital admission for the local province is 9.3 per 1000. Based on this rate, admissions from the other 5 districts are 40-90{\%} of the expected rate. The advantage to local patients cannot be denied, in that health center level admissions receive provincial hospital level care. This simple analysis can be carried out in the health care system of any area. For political and logistical reasons, it may not be possible to eliminate health care differentials based on distance. However, this approach provides an internally consistent method of quantifying those differentials as a 1st step toward reducing them.",
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