The choice of health provider from the patient perspective

Abstract

In recent years, health care consumers (patients) have increasingly been stimulated to take an active role in the decision-making process for providers (hereafter referred to as patient choice). Patient choice is assumed to increase competition between health care providers due to patients voting with their feet. In patient choice, patients are expected to make tradeoffs between the price and quality of care to selectively choose providers who best fit the patients’ preferences. Patient choice has an instrumental value as it aims at improving the efficiency of health care, at achieving better quality of care and at making health providers more responsive to the needs of patients. Patient choice has also an intrinsic value as it acknowledges the autonomy of patients. This dissertation aims to contribute to our understanding of current policies regarding patient choice by addressing research questions related to various aspects of patient choice in the context of the Dutch health care system. To answer these questions, we conducted several discrete choice experiments (DCEs) and a mixed methods study, and performed a longitudinal analysis of scores on quality indicators. The research included in this dissertation has been partitioned into the following parts: patient choice in practice (Part I), the price of care (Part II) and the quality of care (Part III). The conclusions described in this dissertation indicate that, even if patients are in fact willing to become actively involved in patient choice, patients often lack the information on price and quality of care required to make well-informed decisions and effectively exercise choice. Considering the current conditions in practice, we conclude that the underlying assumption of patient choice —i.e. patients select their providers based on information regarding the price and quality of care and in accordance with their preferences— is unlikely to hold true in practice. This overall conclusion indicates the status of “work-in-progress” for current policy regarding patient choice and underlines the need for additional efforts to achieve the goal of patient choice. This dissertation does not provide a definite answer as to whether encouraging patients to become actively involved in patient choice will be successful in achieving the goal of patient choice. Alternatively, additional efforts may be focused on facilitating referring physicians to choose providers on the patient’s behalf. This alternative approach is likely to be the most successful for several reasons. (1) Few patients actively choose their providers or are motivated to so. (2) In real-life settings, individuals are unlikely to conform with the notion of rational consumers. (3) The choice of provider strongly depends on advice of the referring physician.