PHYSICIAN DECISION LOGIC IN RURAL HEALTHCARE NETWORKS - A CROSS-SECTIONAL ANALYSIS OF REFERRAL AND ADMISSION PATTERNS
Author(s)
Christin Juhnke, BSc, MA1, Steffen Fleßa, Prof. Dr.2.
1Research Fellow, PhD Student, University of Greifswald, Greifswald, Germany, 2University of Greifswald, Greifswald, Germany.
1Research Fellow, PhD Student, University of Greifswald, Greifswald, Germany, 2University of Greifswald, Greifswald, Germany.
OBJECTIVES: In peripheral rural regions, outpatient physician referral and hospital admission decisions heavily dictate healthcare steering, resource allocation, and regional care structures. This study aimed to identify quantitative patterns in referral and admission behavior and isolate the primary decision criteria guiding outpatient physicians within a rural healthcare system in a rural region in northern Germany.
METHODS: In spring 2025, a standardized online survey was administered to 677 registered outpatient physicians in a rural district in the north-eastern part of Germany that is the country’s second-largest district by area. The instrument captured quarterly referral and admission volumes, targeted medical specialties, destination clinics, and the perceived relevance of 11 operational and quality-based decision criteria. Data were evaluated via descriptive statistics stratified by gender and specialty, with admission flows mapped cartographically.
RESULTS: From 71 analyzed datasets, 62.5% of physicians regularly issued referrals, generating 31,829 referrals/quarter. General practitioners comprised 45% of this cohort and demonstrated the highest behavioral variance. Diagnostic specialties (radiology, laboratory medicine, cardiology) operated as primary network hubs, whereas therapeutic specialties were less frequently targeted. Admission volumes reflected severe concentration: approx. 1,650 admissions/quarter flowed to the regional maximum-care center, while smaller facilities received marginal shares, reinforcing central-peripheral disparities. Perceived medical competence, specialization degree, and technical equipment were ranked as the top drivers for hospital selection; communication quality and patient satisfaction held moderate importance. Conversely, geographic proximity, organizational workflows, and patient preferences had the lowest impact. Gender-specific analysis revealed that female physicians prioritized nursing quality and communication, whereas male physicians favored structural and technical factors.
CONCLUSIONS: Outpatient steering is heavily diagnostic-oriented, and hospital admissions are strictly driven by perceived quality and specialization, accelerating the centralization of rural care. Optimizing regional health service delivery requires transparent institutional profiles, formalized communication standards, and robust cooperative networks to balance center-periphery dynamics.
METHODS: In spring 2025, a standardized online survey was administered to 677 registered outpatient physicians in a rural district in the north-eastern part of Germany that is the country’s second-largest district by area. The instrument captured quarterly referral and admission volumes, targeted medical specialties, destination clinics, and the perceived relevance of 11 operational and quality-based decision criteria. Data were evaluated via descriptive statistics stratified by gender and specialty, with admission flows mapped cartographically.
RESULTS: From 71 analyzed datasets, 62.5% of physicians regularly issued referrals, generating 31,829 referrals/quarter. General practitioners comprised 45% of this cohort and demonstrated the highest behavioral variance. Diagnostic specialties (radiology, laboratory medicine, cardiology) operated as primary network hubs, whereas therapeutic specialties were less frequently targeted. Admission volumes reflected severe concentration: approx. 1,650 admissions/quarter flowed to the regional maximum-care center, while smaller facilities received marginal shares, reinforcing central-peripheral disparities. Perceived medical competence, specialization degree, and technical equipment were ranked as the top drivers for hospital selection; communication quality and patient satisfaction held moderate importance. Conversely, geographic proximity, organizational workflows, and patient preferences had the lowest impact. Gender-specific analysis revealed that female physicians prioritized nursing quality and communication, whereas male physicians favored structural and technical factors.
CONCLUSIONS: Outpatient steering is heavily diagnostic-oriented, and hospital admissions are strictly driven by perceived quality and specialization, accelerating the centralization of rural care. Optimizing regional health service delivery requires transparent institutional profiles, formalized communication standards, and robust cooperative networks to balance center-periphery dynamics.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD47
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Organizational Practices
Disease
No Additional Disease & Conditions/Specialized Treatment Areas