Mobile phone data shows spatial and socioeconomic inequalities in hospital utilization

This study examines hospital bypass behaviour in China, where patients often forgo nearby hospitals and travel farther for better care. Using anonymized mobile-phone data from 96 million users across 11 Chinese cities, we reveal how widespread this behaviour is, how it varies across socioeconomic groups, and what behavioural mechanisms drive it. The findings show that lower-income groups often shoulder a greater travel burden to compensate for structural spatial disadvantages in access to high-quality healthcare.

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Key Findings

Hospital bypass behaviours and their costs in China.

The study reveals that hospital bypass behaviour is prevalent in China, with 80.63% of healthcare trips involving patients choosing a more distant hospital instead of the nearest available facility. Only 19.37% of patients visit the nearest hospital. This widespread bypass behaviour comes with significant costs in terms of additional travel distance, with actual medical travel distance increasing by 211.84% on average relative to choosing the nearest hospital. The prevalence and travel burden of bypass vary across city types and urban areas, and are especially pronounced in megacities and major cities.

Role of hospital grade and reputation in hospital bypass behaviour.

Hospital quality is strongly related to hospital bypass. As bypass rate, bypass intensity, and extra travel distance increase, the share of patients visiting tertiary Grade A hospitals and prestigious tertiary hospitals rises by approximately 19% and 15%, respectively. These results show that patients primarily bypass nearby hospitals in order to seek better-quality care, especially hospitals with higher grade, stronger capability, and better reputation.

Economic disparities and hospital bypass behaviour.

SES emerges as a critical determinant of bypass behaviour, with low-SES patients exhibiting a paradoxical pattern: lower bypass rates but stronger bypass intensity when they do bypass. Compared with high-SES patients, low-SES patients have a 14.01% lower bypass rate, but skip 8.02% more hospitals and travel 206.62% farther. Behavioural and structural analyses further show that this pattern reflects unequal access to high-quality healthcare near home rather than weaker demand for quality. Low-SES groups face poorer local medical resources and therefore must undertake more intensive compensatory travel to obtain acceptable care.

Reduced social segregation from hospital bypass behaviour.

Hospital bypass behaviour is associated with substantially reduced social segregation at hospital sites, especially for low-SES patients. As bypass behaviour increases, the experienced segregation (ES) index declines by 42.15% for low-SES patients, compared with 8.39% for high-SES patients. At the same time, the experienced socioeconomic class (ESC) index for low-SES patients rises markedly, indicating that they increasingly access hospitals more commonly used by higher-SES groups. These findings suggest that hospital bypass may help reduce experienced social segregation in actual hospital utilization.

The trade-offs between quality and distance in hospital choice.

Discrete-choice modelling shows that hospital bypass is driven by a significant trade-off between hospital quality and travel distance. Patients show strong preferences for higher-grade hospitals, larger hospital capability, and better reputation, alongside clear distance aversion. While patients across SES groups value hospital quality in broadly similar ways, they differ strongly in distance sensitivity. Low-SES patients exhibit a 5.9-fold stronger willingness to travel for hospital quality: for a one-grade hospital upgrade, they are willing to travel about 10 km, compared with only 1.7 km for high-SES patients. This helps explain the apparent paradox in the descriptive results: low-SES patients bypass less often overall, but when they do bypass, they travel much farther because bypass serves as a compensatory mechanism to overcome structural deficits in local medical quality.