When deciding on a health care provider, patients choose the default option
Although patients appreciate having options, the majority of them opt for the default health care provider. The image of patients as selective health care consumers is not entirely consistent with reality. This has emerged from research conducted at the Netherlands Institute for Health Services Research (NIVEL) by Aafke Victoor for her doctoral thesis. She received her PhD from Tilburg University on May 29.
In the Dutch health care system, regulated competition between health care providers is intended to control costs and improve and safeguard the quality, efficiency, and accessibility of health care. So, being able to choose between providers is an end in itself as well as a way to encourage competition between them. However, instead of actively choosing a health care provider, most patients opt for the default provider, for example, the closest hospital or the physiotherapist around the corner.
Loyalty
Aafke Victoor: “In general, patients aren’t concerned about the choice of health care provider. There’s no reason for them to be, because they’re satisfied with, and loyal to, the default health care provider or the doctor who referred them. Others aren't even given the opportunity to actively choose, mainly because there was never a clear moment during their care pathway when they could have done so.”
Barriers
A number of barriers to patient choice will be eliminated by taking measures to both encourage these choices and make them possible, such as by publishing comparative information. “However, most barriers are inherent to the health care sector,” according to Victoor. “For example, a patient has to choose a hospital when they receive a referral from their doctor, even though they don’t yet know what the diagnosis is. Although being able to choose is consistent with free markets where autonomous individuals make independent choices between specific, well-defined products, it would seem that this doesn’t fit within the context of the health care sector. Another kind of logic – namely, the logic of caring – is more appropriate when it comes to describing health care.”
Better experiences
But this doesn’t mean that no one makes choices or is able to choose, or that patients don’t value the opportunity to choose. A small group of patients does in fact make such choices. In addition, patient choice is associated with better experiences among patients. Even though most patients don’t actively choose for the highest quality hospital, they still appreciate having the freedom to choose “their” health care provider, which corresponds with patient choice as an aim in itself.
General practitioners
“For this reason, it’s important to offer choices to patients throughout the entire course of their care pathway, and to make them aware that they are free to choose,” says Victoor. “Because patients and their general practitioners [GPs] work together as a team to improve the patient's health, GPs are probably in the best position to help patients choose a health care provider that fits their needs and preferences.”
Research
During her research, Aafke Victoor conducted a literature review, interviewed patients in hospitals, and studied recordings of GP consultations to see whether they reflected policies on patient choice.
Funding
Ministery of Education, Culture and Science