Lincoln, Neb. Losing customers is something every business worries about.  Hospitals, though not always thought of as business entities in the conventional sense, can be grouped into this same category when the topic of patient outmigration arrives at the table.  Hospitals and health systems are faced with the struggle of sustaining themselves and bringing in new business just the same as a restaurant or department store.  To that end, losing customers can be downright damaging.  Healthcare Market Guide (HCMG) chronicles the phenomenon of patient outmigration in its annual survey of the top 200 US markets.

According to HCMG, nearly 1 in 5 people (17.4 percent) have left the area they reside in to seek care somewhere else.  The distance traveled to receive that care varied to a degree, but 60 99 miles was the clear favorite with 16.1 percent of outmigrators reporting that amount.  20 29 miles was second with 11.8 percent of respondents.  28.3 percent of outmigrators reporting traveling a distance of over 100 miles to receive care.  HCMG data shows that outmigration is up this year, 1.3 percent higher than the 16.1 percent who reported leaving the area in 2006.  Clearly, the willingness of patients to travel out of their area of residence, and the willingness to travel far, demonstrates the concern that hospitals face in the battle to keep their local patients.

Perhaps more drill-down is needed to see what reasons are given by outmigrators.  When looking at HCMGs outmigration data, clinical expertise of provider outside of the area was the biggest motivator for someone to outmigrate (46 percent), with services not offered in area (39 percent) and good reputation of provider outside of the area (37 percent) being important factors as well. 

What kind of service are outmigrators seeking by traveling far and wide?  Nationwide, Heart Care (13.9 percent), Orthopedic Treatment and Surgery (13 percent), Neurology (11.5 percent), and Cancer Treatment (9.5 percent) were the top services sought.  Of those, we can drill down into the HCMG data and see the average miles traveled out of the market for each of these popular services.  Cancer had the highest average miles traveled at 178.  Orthopedic Treatment and Surgery checked in at 143 miles, Neurology at 134 miles and Heart Care at 124 miles. 

Altogether 15 different services were represented as reasons to leave the area for care, and beyond that 31.7 percent of respondents indicated Other as the reason leaving us to believe that the variety of services sought by outmigrators is quite expansive.  HCMG allows the ability to drill down into specific markets and custom areas to see exactly which services outmigrators are leaving the area for and how far they are traveling to seek out treatment.  Although the issue of outmigration is broad and far-reaching by nature, it can be contained as a market-by-market problem to be analyzed more closely by concerned facilities.

If outmigrators are finding hospitals with a certain expertise or treatment, and traveling far in some cases to seek out this new hospital, they must have deep pockets, right?  HCMG data would indicate otherwise:

- Households earning below $25,000 reported 20.5 percent
  outmigration.

- Those earning $25k to $50k reported 17.9 percent outmigration. 

- Those earning $50k to $100k reported 16.4 percent outmigration. 

- Those earning over $100k reported just 16.1 percent outmigration.

The poorest households had the highest outmigration rate, while those earning over $100k had the lowest outmigration rate of all. 

Perhaps any common perceptions of outmigration in healthcare should be thrown out the window.  Reasons behind the phenomenon are varied and selective and those who are traveling for care seem to be comprised of just about everyone in some way or shape.  HCMG clients will find local outmigration figures on their local residents through the Healthcare Market Guide online application, from which outmigration has its own section of data including demographic profiles of outmigrators and state and county averages on the topic.  With competition in healthcare continuing to heat up, outmigration could become an issue that boils over with many facilities.  Finding out whose leaving and why could be crucial to stopping the strain of patient drain.

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