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BMC Health Services Research
Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

Authors: Hans O Birk, Rikke Gut, Lars O Henriksen

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

Research on patients' choice of hospital has focused on inpatients' rather than outpatients' choice of provider. We have investigated Danish outpatients' awareness and utilisation of freedom of choice of provider; which factors influence outpatients' choice of hospital, and how socio-demographic variables influence these factors in a single uptake area, where patients were free to choose any public hospital, where care was provided free at the point of delivery, and where distance to the closest hospitals were short by international standards.

Methods

Retrospective questionnaire study of 4,232 outpatients referred to examination, treatment, or follow-up at one of nine somatic outpatient clinics in Roskilde County in two months of 2002, who had not been hospitalised within the latest 12 months. The patients were asked, whether they were aware of and utilised freedom of choice of hospital.

Results

Fifty-four percent (2,272 patients) filled in and returned the questionnaire. Forty-one percent of respondents were aware of their right to choose, and 53% of those patients utilised their right to choose. Awareness of freedom of choice of provider was reported to be especially high in female outpatients, patients with longer education, salaried employees in the public sector, and in patients referred to surgical specialties. Female outpatients and students were especially likely to report that they utilised their right to choose the provider. Short distance was the most important reason for outpatients' choice, followed by the GP's recommendations, short waiting time, and the patient's previous experience with the hospital.

Conclusions

Outpatients' awareness and utilisation of free choice of health care provider was low. Awareness of freedom of choice of provider differed significantly by specialty and patient's gender, education and employment. Female patients and students were especially likely to choose the clinic by themselves. Most outpatients chose the clinic closest to their home, the GP's recommendation and short waiting time being the second and third most important factors behind choice.
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Literature
1.
Winblad U, Ringard Å: Meeting rising public expectations: the changing roles of patients and citizens. Nordic health care systems. Recent reforms and current policy challenges. Edited by: Magnussen J, Vrangbæk K, Saltman RB. 2009, Maidenhead: Open University Press
2.
Le Grand J: Motivation, agency, and public policy. Of Knights & Knaves, Pawns & Queens. 2003, Oxford: Oxford University PressCrossRef
3.
Vrangbæk K, Østergren K: Patient empowerment and the introduction of hospital choice in Denmark and Norway. Health Economics, Policy and Law. 2006, 1: 371-94. 10.1017/S1744133106005032.CrossRef
4.
Dixon A, Robertson R, Appleby J, Burge P, Devlin N, Magee H: Patient choice. How patients choose and how providers respond. 2010, London: The King's Fund
5.
Perri G: Giving consumers of British public services more choice: what can be learned from recent history?. Jnl Soc Pol. 2003, 32: 239-70. 10.1017/S0047279402006980.CrossRef
6.
Thomson S, Dixon A: Choices in health care: the European experience. J Health Serv Res Policy. 2006, 11: 167-71. 10.1258/135581906777641703.CrossRefPubMed
7.
Kreisz FP, Gericke C: User choice in European health systems: towards a systematic framework for analysis. Health Econ Policy Law. 2010, 5: 13-30. 10.1017/S1744133109990132.CrossRefPubMed
8.
Dowding K, John P: The value of choice in public policy. Public Administration. 2009, 87: 219-33. 10.1111/j.1467-9299.2008.01732.x.CrossRef
9.
Wilmot S: A fair range of choice: justifying maximum patient choice in the British National Health Service. Health Care Anal. 2007, 15: 59-72. 10.1007/s10728-006-0032-6.CrossRefPubMed
10.
Porter ME, Teisberg EO: Redefining Health Care. Creating value-based competition on results. 2006, Cambridge, Harvard Business School Press
11.
Appleby J, Harrison A, Devlin N: What is the real cost of more patient choice. 2003, London: King's Fund
12.
Vrangbæk K: The interplay between central and sub-central levels: the development of a systematic standard based programme for governing medical performance in Denmark. Health Econ Policy Law. 2009, 4: 305-27. 10.1017/S1744133109005040.CrossRefPubMed
13.
Tai-Seale M: Voting with their feet: patient exit and intergroup differences in propensity for switching usual sources of care. J Health Polit Policy Law. 2004, 29: 491-514. 10.1215/03616878-29-3-491.CrossRefPubMed
14.
Le Grand J: Choice and competition in publicly funded health care. Health Economics, Policy and Law. 2009, 4: 479-88. 10.1017/S1744133109990077.CrossRef
15.
Hayek FA: The use of knowledge in society. American Economic Review. 1945, 35: 519-30.
16.
Hirschman AO: Exit, voice and loyalty. Response to decline in firms, organizations and states. 1970, Cambridge: Harvard University Press
17.
Bernstein AB, Gauthier AK: Choices in health care: what are they and what are they worth?. Med Care Res Rev. 1999, 56: 5-23. 10.1177/107755899773743846.CrossRefPubMed
18.
Martinsen DS, Vrangbæk K: The Europeanization of health care governance: implementing the market imperatives of Europe. Public Administration. 2008, 86: 169-84. 10.1111/j.1467-9299.2007.00702.x.CrossRef
19.
Lewis R: More patient choice in England's National Health service. International Journal of Health Services. 2005, 35: 479-83. 10.2190/LTYA-7TK6-9EWT-583D.CrossRefPubMed
20.
Vrangbæk K, Østergren K, Birk HO, Winblad U: Patient reactions to hospital choice in Norway, Denmark and Sweden. Health Economics, Policy and Law. 2007, 2: 125-52. 10.1017/S174413310700401X.CrossRef
21.
Berendsen AJ, de Jong GM, Schuling J, Bosveld HEP, de Waal MWM, Mitchell GK, van der Meer K, Meyboom-de-Jong B: Patients' need for choice and information across the interface between primary and secondary care: A survey. Patient Education and Counseling. 2010, 79: 100-5. 10.1016/j.pec.2009.07.032.CrossRefPubMed
22.
Lisac M, Reimers L, Henke KD, Schlette S: Access and choice - competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004. Health Economics, Policy and Law. 2010, 5: 31-52. 10.1017/S1744133109990144.CrossRef
23.
Shannon GW, Bashshur RL, Metzner C: The concept of distance as a factor in accessibility and utilization of health care. Medical Care Review. 1969, 26: 143-61.CrossRef
24.
Porell FW, Adams EK: Hospital choice models: a review and assessment of their utility for policy impact analysis. Med Care Res Rev. 1995, 52: 158-95. 10.1177/107755879505200202.CrossRefPubMed
25.
Place M: The relationship between concentration, patient accessibility and utilisation of services. 1997, York: The University of York. Centre for Health Economics. York Health Economics Consortium. NHS Centre for Reviews & Dissemination
26.
Indenrigs- og Sundhedsministeriet: Sundhedsvæsenet i nationalt perspektiv. 2010, Copenhagen, In Danish: the Danish Ministry of the Interior and Health. The health care system in a national perspective
27.
Unit of Patient Evaluation: Patienters vurdering af landets sygehuse 2000. Spørgeskemaundersøgelse blandt 34.000 patienter [in Danish: Patients' experiences with hospitals in Denmark 2000. Questionnaire study including 34,000 patients]. 2001, Glostrup: Enheden for brugerundersøgelser i Københavns Amts sundhedsvæsen [Unit of Patient Evaluation, Copenhagen County
28.
Goddard M, Hobden C: Patient Choice: a review. Report to the Department of Health. 2003, York: Centre for Health Economics
29.
Godager G, Iversen T: Hvem bruker retten til fritt sygehusvalg? Resultater fra Samordnet levekårsundersøkelse 2002. Økonomisk Forum. 2004, 58 (4/5): 49-56. In Norwegian Who utilises the right of freedom of choice of hospital? Results from the integrated study of living conditions 2002
30.
Strandberg-Larsen M, Nielsen MB, Vallgårda S, Krasnik A, Vrangbæk K, Mossialos E: Denmark: Health system review. Health Systems in Transition. 2007, 9 (6): 1-164.
31.
32.
Unit of Patient Evaluation: Patienters vurdering af landets sygehuse 2002. Spørgeskemaundersøgelse blandt 32.000 patienter [in Danish: Patients' experiences with hospitals in Denmark 2002. Questionnaire study including 32,000 patients]. 2003, Glostrup: Enheden for brugerundersøgelser i Københavns Amts sundhedsvæsen [Unit of Patient Evaluation, Copenhagen County]
33.
Unit of Patient Evaluation: Patienters vurdering af sygehusafdelinger i Roskilde Amt. Spørgeskemaundersøgelse blandt 3.400 patienter [in Danish: Patients' experiences with hospital departments in Roskilde County 2002. Questionnaire study including 3,400 patients]. 2003, Glostrup: Enheden for brugerundersøgelser i Københavns Amts sundhedsvæsen [Unit of Patient Evaluation, Copenhagen County
34.
Unit of Patient Evaluation: Patienters oplevelser på landets sygehuse 2004. Spørgeskemaundersøgelse blandt 26.300 indlagte patienter [in Danish: Patients' experiences with hospitals 2004. Questionnaire study including 26,300 inpatients]. 2004, Glostrup: Enheden for Brugerundersøgelser i Københavns Amt. [Unit of Patient Evaluation, Copenhagen County], 2005. Abstract in English available at: http://​www.​patientoplevelse​r.​dk/​index.​asp?​id=​210 [homepage on the Internet] [cited on 3 July 2011], . Spørgeskemaundersøgelse blandt 26.300 indlagte patienter [in Danish: Patients' experiences with hospitals 2004. Questionnaire study including 26,300 inpatients]
35.
Boyce T, Dixon A, Fasolo B, Reutskaja E: Choosing a high-quality hospital. The role of nudges, scorecard design and information. 2010, London: The King's Fund
36.
Combier E, Zeitlin J, de Courcel N, Vasseur S, Lalouf A, Amat-Roze JM, de Pouvourville G: Choosing where to deliver: decision criteria among women with low-risk pregnancies in France. Soc Sci Med. 2004, 58: 2279-89. 10.1016/j.socscimed.2003.08.015.CrossRefPubMed
37.
Tai WTC, Porell FW, Adams EK: Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient-physician relationship. Health Serv Res. 2004, 39: 1903-22. 10.1111/j.1475-6773.2004.00324.x.CrossRefPubMedPubMedCentral
38.
Adams EK, Wright GE: Hospital Choice of Medicare Beneficiaries in a Rural Market: Why not the Closest?. J Rural Health. 1991, 7: 134-52. 10.1111/j.1748-0361.1991.tb00715.x.CrossRefPubMed
39.
Conner-Spady B, Sanmartin C, Johnston G, McGurran J, Kehler M, Noseworthy T: Willingness of patients to change surgeons for a shorter waiting time for joint arthroplasty. CMAJ. 2008, 179: 327-32. 10.1503/cmaj.071659.CrossRefPubMedPubMedCentral
40.
Dunn E, Black C, Alonso J, Nørregaard JC, Anderson GF: Patients' acceptance of waiting time for cataract surgery: what makes a wait too long?. Soc Sci Med. 1997, 44: 1603-10. 10.1016/S0277-9536(96)00251-1.CrossRefPubMed
41.
Howell GP, Richardson D, Forester A, Sibson J, Ryan JM, Morgans BT: Long distance travel for routine elective surgery: questionnaire survey of patients' attitudes. BMJ. 1990, 300: 1171-3. 10.1136/bmj.300.6733.1171.CrossRefPubMedPubMedCentral
42.
Nofal F, Moran MM: Long distance travel by children for tonsillectomy: experience of the ORL department at Princess Alexandra Hospital (PAH), Royal Air Force, Wroughton, Swindon. J Laryngol Otol. 1990, 104: 417-8.CrossRefPubMed
43.
Dawson D, Jacobs R, Martin S, Smith P: Is patient choice an effective mechanism to reduce waiting times?. Appl Health Econ Health Policy. 2004, 3: 195-203. 10.2165/00148365-200403040-00003.CrossRefPubMed
44.
Burge P, Devlin N, Appleby J, Rohr C, Grant J: Do patients always prefer quicker treatment?: a discrete choice analysis of patients' stated preferences in the London Choice Project. Appl Health Econ Health Policy. 2004, 3: 183-94. 10.2165/00148365-200403040-00002.CrossRefPubMed
45.
Derrett S, Paul C, Moris JM: Waiting for elective surgery: effects on health-related quality of life. Int J Qual Health Care. 1999, 11: 47-57. 10.1093/intqhc/11.1.47.CrossRefPubMed
46.
Wolinsky FD, Kurz RS: How the public chooses and views hospitals. Hosp Health Serv Adm. 1984, 29: 58-67.PubMed
47.
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: 1866-74. 10.1001/jama.283.14.1866.CrossRefPubMed
48.
Robinson S, Brodie M: Understanding the quality challenge for health consumers. The Kaiser/AHCPR Survey. Jt Comm J Qual Improv. 1997, 23: 239-44.PubMed
49.
Mennemeyer ST, Morrisey MA, Howard LZ: Death and reputation: how consumers acted upon HCFA mortality information. Inquiry. 1997, 34: 117-28.PubMed
Metadata
Title
Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey
Authors
Hans O Birk
Rikke Gut
Lars O Henriksen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-262

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