The impact of quality on hospital choice. Which information affects patients’ behavior for colorectal resection or knee replacement?

Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients’ hospital choice. We use data from ~145,000 German patients and ~ 900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients’ marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to be present. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients’ hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns.

Do patients value similar hospital characteristics and quality metrics for different treatments?

Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients' hospital choice. We use data from ∼145,000 German patients and ∼900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients' marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to work. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients' hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns. Consequently, future quality transparency initiatives need to entail the development and publication of understandable outcome quality indicators (e.g. patient reported outcome measures). Moreover, clinical quality indicators need to be explained and presented more intuitively. Key messages Quality competition among hospitals is beneficial for all participants in the health care system. Our paper reveals the quality information that is decisive in the patient’s decision making process. Accessibility and comprehensibility of quality information plays a large role in its impact on patient hospital choice. Thus, policy makers need to raise quality transparency and patient emancipation.

Word-of-Mouth (WOM) distribution and intensity after elective surgery in relation to the decisive hospital choice process, satisfaction and recommendation

Background Patients frequently use experience-based sources when choosing a hospital, most often in form of word-of-mouth (WOM), which is perceived to be independent of direct information from providers. There is scarce data on the prevalence and intensity of WOM in the medical context. Methods This exploratory cohort study recruited patients for elective surgery at two maximum care facilities. In addition to demographic data, information sources used and determinant factors for decisive hospital choice were evaluated. After hospital discharge, a telephone interview was used to inquire about the state of health, complications, overall satisfaction, the extent and intensity of positive and negative communication and the estimated number of people reached by WOM. Results 348 questionnaires were evaluated and 231 patients were reached by telephone. Main sources for the hospital choice were the GP/specialist doctors, family and friends. Decisions were eventually based on the GP/specialist doctors, the hospital reputation and the spectrum of care provided by the hospitals. Post discharge, 94 patients were satisfied, 30 dissatisfied (107 neutral) with the care provided. After the operation, 120 had had contact with their GP/specialist doctors, 226 to family and friends, 129 to others, including 105 responses to the hospital staff. Postoperative persisting pain and a slow recovery to normal function were associated with lower satisfaction scores (p<0.05). Satisfied patients had given mostly positive (ratio 11.6: 1), neutral predominantly positive (ratio 2.2:1), dissatisfied rather negative (ratio 1:1.2) information to others. Per patient, positive aspects were passed on to 12, negative to 4 persons. All satisfied and 46.7% of dissatisfied patients would recommend the hospital to their family and friends. Conclusion WOM was found to correlate to satisfaction, with different proportions of positive and negative communication along the satisfaction continuum. Overall, the communication of positive aspects dominates