Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing

Abstract

Health plans are encouraging consumerism among joint replacement patients by reporting information on hospital costs and quality. Little is known about how the proliferation of such initiatives impacts patients’ selection of a surgeon and hospital. We performed a qualitative analysis of semistructured interviews with 13 patients who recently received a hip or knee replacement surgery. Patients focused on the choice of a surgeon as opposed to a hospital, and the surgeon choice was primarily made based on reputation. Most patients had long-standing relationships with an orthopedic surgeon and tended to stay with that surgeon for their replacement. Despite growing availability of cost and quality information, patients almost never used such information to make a decision.

Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

“…In line with previous research [23], reputation was very important to our participants for choosing a hospital. The results highlight the importance of social and communication skills of physicians [27,42,57]. As shown by others [26,56], some of our participants would also search the internet.…”

“…In general, patients consider a variety of structural, process and quality characteristics of providers [25]. Knee or hip arthroplasty patients rely on their own experience, recommendations by others (friends, family, and primary care providers), or information they find on the internet or in magazines [26,27]. When candidates for hip or knee replacement surgery decide on a hospital, they consider outcome quality (infection rates, complication rates) [26], postoperative pain management [26], and other factors such as kindness of the staff [26], surgeon reputation [23] and waiting time [23].…”

“…A Cochrane review found evidence that public dissemination of quality information may make little or no difference to the long-term healthcare utilisation by consumers [48]. Publicly available quality information played no role in the patients' choice of a provider for hip and knee arthroplasty [27]. There are multiple reasons for these findings.…”

“…While it was possible to address these questions in the context of the current study (during the interviews), patients typically have to understand the quality information without assistance. In sum, the usage of information regarding hospital quality is low among patients [27,50,52]. Possible reasons may be that patients trust their physicians to refer them to a hospital with expertise or expect the operating surgeons to tell them if the surgery was too complicated to be performed in a low-volume hospital [41] and therefore feel no need for more information [53].…”

Which patients receive surgery in for-profit and non-profit hospitals in a universal health system? An explorative register-based study in Norway

“…Time spent on waiting lists, staff qualifications and experience 21 and surgeon reputation 23 have been found to be important determinants of hospital choice. Additionally, in the Norwegian FHCS, patients with high income and high levels of education are found to be more active in choosing hospitals.…”