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Determinants of patient choice of health care providers: a scoping review.

Victoor, A., Delnoij, D.M.J., Friele, R.D., Rademakers, J.J.D.J.M. Determinants of patient choice of health care providers: a scoping review. European Journal of Public Health: 2012, 22(suppl. 2), p. 264. Abstract. 5th European Public Health Conference 'All inclusive public health'. 7-10 November 2012, St. Julians (Malta).
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Background: In several North-Western European countries, a demand driven health care system has been implemented that stresses the importance of patient choice of health care providers. Patients are assumed to actively choose the best provider with the lowest costs. This selection prompts providers to compete for them by improving their value-for-money ratio. However, quality and costs may not be the only information kinds that patients use during their selection process. Therefore, it is time to gather information on what is known about the factors that influence patients’ choices. In the current study, we aim to describe the findings and range of research concerning this issue and to identify knowledge gaps. Methods: We performed a specific kind of literature review: a scoping review. Its aim is to appreciate the breadth of knowledge that is
available on a particular topic. First, we identified research questions and searched literature in Embase, Medline and PubMed. Second, we selected the literature, and finally, we charted and summarized the information. Results: 116 studies were included. Patients’ choices are determined by a complex interplay between patient and provider characteristics. Several patient characteristics determine whether and how patients choose. Patients take a variety of structure, process and outcome characteristics of providers into account and differ in the relative importance they attach to all characteristics. Conclusions: Different patients make different choices in different situations. Objective quality information has a relatively limited influence on the choices of many patients and patients base their decisions on a variety of provider characteristics. The assumptions made in health policy regarding patient choice may therefore be an oversimplification of reality. As a result, patient choice of health care providers may not have the expected effects in countries in which patient choice has a pivotal role as a mechanism to improve the quality and efficiency of health care. (aut. ref.)