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Ranking Sources of Hospital Quality Information for Orthopedic Surgery Patients: Consequences for the System of Managed Competition

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Abstract

Background

Healthcare quality information is crucial for the system of managed competition. Within a system of managed competition, health insurers can selectively contract care providers and are allowed to channel patients towards contracted providers. The idea is that insurers have a stronger bargaining position compared to care providers when they are able to channel patients. In the Dutch system of managed competition that was implemented in 2006, channelling patients to preferred providers has not yet been very successful. Empirical knowledge of which sources of hospital quality information they find important may help us to understand how to channel patients to preferred providers.

Objectives

The objective of this survey was to measure how patients rank various sources of information when they compare hospital quality in a system of managed competition.

Methods

A written survey was conducted among clients of a large Dutch health insurance company. These clients underwent orthopedic surgery on the hip or knee no longer than 12 months ago.

Results

Two major players within a system of managed competition—health insurers and the government—were not seen as important sources of hospital quality information. In contrast, own experience and general practitioners (GPs) were seen as the most important sources of hospital quality information within the Dutch system of managed competition.

Conclusions

Health insurers should take the main finding—that GPs are the most important source of hospital quality information—into account when they contract care providers and develop strategies for channeling patients towards preferred providers. A well-functioning system of managed competition will benefit patients, as it involves incentives for care providers to increase healthcare quality and to produce at the lowest cost per unit of quality.

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Notes

  1. See Mosca and Schut-Welkzijn [21] for an introduction to determinants of choice behavior in the Dutch health insurance market.

  2. Enthoven and Van de Ven [1] give more details of the Dutch Health Insurance Act and also outline how the new Dutch system could be implemented in the United States.

  3. Varkevisser and Van der Geest [22] list determinants of hospital choice: proximity/accessibility, hospital reputation, (perceived) hospital expertise, previous experiences with a hospital, waiting time, 24/7 availability of an emergency department, a guaranteed regular physician, sufficient parking facilities, and participation in a regional network of health providers. They also investigate the reasons that lead consumers to bypass their nearest hospital. Results indicate that travel time and hospital attributes (greater size and scope) as well as patient attributes (age and income) significantly affect the decisions of patients to bypass the nearest hospital. Please note that their study does not say anything about consumers’ sources of hospital quality information.

  4. We are aware of two other studies that measure channeling to preferred providers in Dutch healthcare. Boonen et al. [4] measure how to channel enrollees from health insurance plans to preferred providers in the Dutch pharmacy market. Regarding channeling consumers to GPs, Boonen [23] uses a discrete choice experiment to show that consumers prefer to stick with their current GP, even when there is a very attractive preferred provider GP. Please note that neither of these two studies measured sources of quality information.

  5. Survey questions are partly based on a survey of the Dutch Healthcare Authority that is not published in English and also does not discuss implications of the findings for the theoretical concept of managed competition [14].

  6. Choice options are partially based on a survey of the Dutch Health Care Authority in 2007 [14]. Results are not published in the international literature. Sources of included information are the patient’s GP, government websites, their family and friends, and their health insurer. We added national ranking performed by national newspapers/journals to this list, as they are potentially another source that patients find important. We also added own experience because we asked a sample of patients, implying they could consider own experience as well as patient/consumer organizations, as they increasingly publish quality information [24].

  7. Although the exact survey question did not state that it was about importance when comparing care providers, for instance to choose a hospital, this was clear from the content of the survey and the other survey questions, including questions on how they had selected a hospital for treatment previously, as well as if and how they had previously searched for quality information.

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Acknowledgements

No sources of funding were used to conduct this study or to prepare this manuscript. The authors declare that they have no conflicts of interest relevant to the content of this article. We gratefully acknowledge the comments and suggestions of four anonymous reviewers and those of the Associate Editor Tim Wrightson. RB was responsible for the development of the survey, data collection, and data analysis. Both authors interpreted and discussed the results and their implications, and drafted and wrote the article. RB is the guarantor for the overall content.

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Authors and Affiliations

  1. NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands

    Romy Evelien Bes

  2. Centre for Health Economics, Alcuin ‘A’ Block, University of York, Heslington, York, YO10 5DD, UK

    Bernard van den Berg

Authors
  1. Romy Evelien Bes
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  2. Bernard van den Berg
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Correspondence to Romy Evelien Bes.

Appendix: Survey Questions

Appendix: Survey Questions

The box below presents seven sources of hospital quality information.

figure a

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Bes, R.E., van den Berg, B. Ranking Sources of Hospital Quality Information for Orthopedic Surgery Patients: Consequences for the System of Managed Competition. Patient 6, 75–80 (2013). https://doi.org/10.1007/s40271-013-0011-6

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