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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Hospital choice in Germany from the patient’s perspective: a cross-sectional study

Authors: Werner de Cruppé, Max Geraedts

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports. Previous studies on hospital choice mainly have focused on patients undergoing elective surgery. This study examined a representative sample of hospital inpatients across disciplines and treatment interventions in Germany. Its research questions were: How many patients decide where to go for hospital treatment? How much time do patients have before admission? Which sources of information do they use, and which criteria are relevant to their decision?

Methods

Cross-sectional observational study covering 1925 inpatients of 46 departments at 17 hospitals in 2012. The stratified survey comprised 11 medical disciplines (internal medicine, gynaecology, obstetrics, paediatrics, psychiatry, orthopaedics, neurology, urology, ENT and geriatrics) on 3 hospital care levels representing 91.9% of all hospital admissions to inpatient care in Germany in 2012. The statistical analysis calculated the frequency distributions and 95% confidence intervals of characteristics related to the hospital choice.

Results

63.0% [60.9–65.2] of patients in Germany chose the hospital themselves, but only 21.1% [19.3–22.9] had more than one week to decide prior to admission. Major sources of information were personal knowledge of hospitals, relatives, outpatient health professionals and the Internet. Main criteria for the decision were personal experience with a hospital, recommendations from relatives and providers of outpatient services, a hospital’s reputation and distance from home. Specific quality information as provided by performance reports were of secondary importance.

Conclusions

A majority of patients in the German health system choose their hospital freely. Providers of outpatient health care can have an important “agent” function in the quality-oriented hospital choice especially for patients with little time prior to admission and those who do not decide themselves. Hospitals have an impact on patients’ future hospital choices by the treatment experience they provide to patients.
Appendix
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Literature
1.
Vrangbaek K, Robertson R, Winblad U, van de Bovenkamp H, Dixon a. Choice policies in northern European health systems. Health economics, Policy and Law. 2012;7(Special Issue 01):47–71.CrossRef
2.
Victoor A, Friele RD, Delnoij DMJ, Rademakers JJDJM. Free choice of healthcare providers in the Netherlands is both a goal in itself and a precondition: modelling the policy assumptions underlying the promotion of patient choice through documentary analysis and interviews. BMC Health Serv Res. 2012;12:441.CrossRefPubMedPubMedCentral
3.
Bernstein AB, Gauthier AK. Choices in health care: what are they and what are they worth? Med Care Res Rev. 1999;56(Suppl 1):5–23.CrossRefPubMed
4.
Kolstad JT, Chernew ME. Quality and consumer decision making in the market for health insurance and health care services. Med Care Res Rev. 2009;66(1 suppl):28S–52S.CrossRefPubMed
5.
Ringard Å. Equitable access to elective hospital services: the introduction of patient choice in a decentralised healthcare system. Scandinavian Journal of Public Health. 2012;40(1):10–7.CrossRefPubMed
6.
Costa-i-Font J, Zigante V. ‘The Choice Agenda’ in European Health Systems: The Role of ‘Middle Class Demands’. The London School of Economics and Political Science ‚Europe in Question’ Discussion Paper Series. LEQS Paper No. 82/2014. https://​doi.​org/​10.​2139/​ssrn.​2522841 Accessed 10. Oct 2017.
7.
Hibbard JH, Greene J, Sofaer S, Firminger K, Hirsh J. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff. 2012;31(3):560–8.CrossRef
8.
Or Z, Cases C, Lisac M, Vrangbæk K, Winblad U, Bevan G. Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems. Health Economics, Policy and Law. 2010;5(3):269–93.CrossRefPubMedPubMedCentral
9.
Lako CJ, Rosenau P. Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice. Health Care Anal. 2009;17(1):20–35.CrossRefPubMed
10.
Dixon A, Robertson R, Bal R. The experience of implementing choice at point of referral: a comparison of the Netherlands and England. Health Economics, Policy and Law. 2010;5(3):295–317.CrossRef
11.
Thomson S, Dixon A. Choices in health care: the European experience. Journal of Health Services Research & Policy. 2006;11(3):167–71.CrossRef
12.
Foster MM, Earl PE, Haines TP, Mitchell GK. Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care. Health Policy. 2010;97(2–3):105–12.CrossRefPubMed
13.
Losina E, Plerhoples T, Fossel AH, et al. Offering patients the opportunity to choose their hospital for total knee replacement: impact on satisfaction with the surgery. Arthritis. Rheumatism. 2005;53(5):646–52.CrossRef
14.
E a.G J, Defuentes-Merillas L, de Weert GH, Sensky T, Staak CPF v d, C a.J d j. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219–26.CrossRef
15.
Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff. 2015;34(3):431–7.CrossRef
16.
Berwick DM. What “patient-centered” should mean: confessions of an extremist. Health Aff. 2009;28(4):w555–65.CrossRef
17.
Fung CH, Lim Y-W, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148(2):111–23.CrossRefPubMed
18.
19.
20.
Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports that clearly communicate to consumers the meaning of quality of care. Med Care Res Rev. 2010;67(3):275–93.CrossRefPubMed
21.
Damman OC, Hendriks M, Rademakers J, Spreeuwenberg P, Delnoij DMJ, Groenewegen PP. Consumers’ interpretation and use of comparative information on the quality of health care: the effect of presentation approaches. Health Expect. 2012;15(2):197–211.CrossRefPubMed
22.
Dijs-Elsinga J, Otten W, Versluijs MM, et al. Choosing a hospital for surgery: the importance of information on quality of care. Med Decis Mak. 2010;30(5):544–55.CrossRef
23.
Vaiana ME, McGlynn EA. What cognitive science tells us about the Design of Reports for consumers. Med Care Res Rev. 2002;59(1):3–35.CrossRefPubMed
24.
Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data - what do we expect to gain? A review of the evidence. JAMA. 2000;283(14):1866–74.CrossRefPubMed
25.
Zwijnenberg NC, Hendriks M, Damman OC, et al. Understanding and using comparative healthcare information; the effect of the amount of information and consumer characteristics and skills. BMC Medical Informatics and Decision Making. 2012;12:101.CrossRefPubMedPubMedCentral
26.
27.
Turnpenny A, Beadle-Brown J. Use of quality information in decision-making about health and social care services--a systematic review. Health and Social Care in the Community. 2015;23(4):349–61.CrossRefPubMed
28.
Victoor A, Delnoij DMJ, Friele RD, Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res. 2012;12(1):272.CrossRefPubMedPubMedCentral
29.
Ketelaar NABM, Faber MJ, Westert GP, Elwyn G, Braspenning JC. Exploring consumer values of comparative performance information for hospital choice. Qual Prim Care. 2014;22(2):81–9.PubMed
30.
Ketelaar NABM, Faber MJ, Flottorp S, Rygh LH, Deane KHO, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev. 2011;11:CD004538.
31.
Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care. 2009;47(1):1–8.CrossRefPubMed
32.
Geraedts M. Qualitätsberichte deutscher Krankenhäuser und Qualitätsvergleiche von Einrichtungen des Gesundheitswesens aus Versichertensicht. [Quality reports of German hospitals and quality comparisons of health care providers from the perspective of the insured] In: Böcken J, Braun B, Amhof R, Schnee M (eds): Gesundheitsmonitor 2006 [health monitor 2006]. Gesundheitsversorgung und Gestaltungsoptionen aus der Perspektive von Bevölkerung und Ärzten [health care and organization options from the perspective of the general public and physicians]. Gütersloh: Verlag Bertelsmann Stiftung; 2006. p. 154–170.
33.
Marshall M, McLoughlin V. How do patients use information on health providers? Br Med J. 2010;341(nov25 1):c5272.CrossRef
34.
Mansky T. Was erwarten potenzielle Patienten vom Krankenhaus? [What do prospective patients expect from a hospital?] In: Böcken J, Braun B, Repschläger U (eds): Gesundheitsmonitor 2012 [Health Monitor 2012]. Gütersloh: Verlag Bertelsmann Stiftung 2012. p. 136-159.
35.
Streuf R, Maciejek S, Kleinfeld A, Blumenstock G, Reiland M, Selbmann HK. Informationsbedarf und Informationsquellen bei der Wahl eines Krankenhauses. [information needs and information sources in search of a hospital.]. Gesundheitsökonomie und Qualitätsmanagement. 2007;12(02):113–20.
36.
Vonberg R-P, Sander C, Gastmeier P. Consumer attitudes about health care acquired infections: a German survey on factors considered important in the choice of a hospital. Am J Med Qual. 2008;23(1):56–9.CrossRefPubMed
37.
Simon A. Patienteninvolvement und Informationspräferenzen zur Krankenhausqualität. [patient involvement and information preferences on hospital quality. Results of an empirical analysis]. Unfallchirurg. 2011;114(1):73–8.CrossRefPubMed
38.
Marang-van de Mheen PJ, Dijs-Elsinga J, Otten W, et al. The relative importance of quality of care information when choosing a hospital for surgical treatment: a hospital choice experiment. Med Decis Mak. 2011;31(6):816–27.CrossRef
39.
Zwijnenberg NC, Damman OC, Spreeuwenberg P, Hendriks M, Rademakers JJ. Different patient subgroup, different ranking? Which quality indicators do patients find important when choosing a hospital for hip- or knee arthroplasty? BMC Health Serv Res. 2011;11:299.CrossRefPubMedPubMedCentral
40.
Geraedts M, de Cruppé W. Wahrnehmung und Nutzung von Qualitätsinformationen durch Patienten [how patients perceive and use quality information]. In: Klauber J, Geraedts M, Friedrich J, Wasem J, editors. Krankenhaus-report 2011 [hospital report 2011]. Schwerpunkt: Qualität durch Wettbewerb [topic: quality by competition]. Stuttgart: Schattauer; 2011. p. 93–104.
41.
Victoor A, Delnoij D, Friele R, Rademakers J. Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients. Health Expectation. 2014; doi:10.​1111/​hex.​12224.
42.
Groenewoud S, Van Exel NJA, Bobinac A, Berg M, Huijsman R, Stolk EA. What influences patients’ decisions when choosing a health care provider? Measuring preferences of patients with knee arthrosis, chronic depression, or Alzheimer’s disease, using discrete choice experiments. Health Serv Res. 2015; doi:10.​1111/​1475-6773.​12306.
43.
Mühlbacher AC, Bethge S, Reed SD, Schulman KA. Patient preferences for features of health care delivery systems: a discrete choice experiment. Health Serv Res 2015; doi:10.​1111/​1475-6773.​12345.
44.
Tu HT, Lauer JR. Word of mouth and physician referrals still drive health care provider choice. Research Brief. 2008;9:1–8.
45.
Feldman R, Jung K. Testing the Hirshleifer–Riley model: the values of information sources for a future hospital stay. J Consum Policy. 2012;35(3):355–71.CrossRef
46.
Abraham J, Sick B, Anderson J, Berg A, Dehmer C, Tufano A. Selecting a provider: what factors influence patients’ decision making? J Healthc Manag. 2011;56(2):99–114. discussion 114–5PubMed
47.
de Cruppé W, Geraedts M. Wie wählen Patienten ein Krankenhaus für elektive operative Eingriffe? [how do patients choose a hospital for elective surgery?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2011;54(8):951–7.CrossRefPubMed
48.
de Groot IB, Otten W, Dijs-Elsinga J, et al. Choosing between hospitals: the influence of the experiences of other patients. Med Decis Mak. 2012;32(6):764–78.CrossRef
49.
Schwartz LM, Woloshin S, Birkmeyer JD. How do elderly patients decide where to go for major surgery? Telephone interview survey. Br Med J. 2005;331(7520):821.CrossRef
50.
Sofaer S, Crofton C, Goldstein E, Hoy E, Crabb J. What do consumers want to know about the quality of Care in Hospitals? Health Serv Res. 2005;40(6p2):2018–36.CrossRefPubMedPubMedCentral
51.
Leister J, Stausberg J. Why do patients select a hospital? A conjoint analysis in two German hospitals. Journal of hospital marketing & public relations. 2007;17(2):13–31.CrossRef
52.
Rattay P, Butschalowsky H, Rommel A, et al. Utilization of outpatient and inpatient health services in Germany: results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):832–44.CrossRefPubMed
53.
54.
55.
56.
Geuter G, Weber J (2009) Informationsbedarf chronisch kranker Menschen bei der Krankenhauswahl – untersucht unter besonderer Berücksichtigung des Internets [Information need of chronically ill persons when choosing a hospital – analysed in consideration of the internet]. Veröffentlichungsreihe des Instituts für Pflegewissenschaft an der Universität Bielefeld (IPW). P09–140. Bielefeld www.​uni-bielefeld.​de/​gesundhw/​ag6/​downloads/​ipw-140.​pdf Accessed 10 Oct 2017.
57.
Geraedts M, Schwartze D, Molzahn T. Hospital quality reports in Germany: patient and physician opinion of the reported quality indicators. BMC Health Serv Res. 2007;7:157.CrossRefPubMedPubMedCentral
58.
Geraedts M, Hermeling P, de Cruppé W. Communicating quality of care information to physicians: a study of eight presentation formats. Patient Educ Couns. 2012;87(3):375–82.CrossRefPubMed
59.
Rademakers J, Delnoij D, de Boer D. Structure, process or outcome: which contributes most to patients’ overall assessment of healthcare quality? BMJ Quality & Safety. 2011;20(4):326–31.CrossRef
60.
Metadata
Title
Hospital choice in Germany from the patient’s perspective: a cross-sectional study
Authors
Werner de Cruppé
Max Geraedts
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2712-3

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