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

Abstract

BackgroundIn 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?MethodsCross-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.Results63.0% [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.ConclusionsA 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.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2712-3) contains supplementary material, which is available to authorized users.

Are patients willing to accept longer travel times to decrease their risk associated with surgical procedures? A systematic review

“…Research showed that a previously made personal experience of patients in a hospital was an influencing factor [5].…”

“…Besides surgical reputation and surgical competency, hospital reputation and distance to the hospital are the primarily important attributes by which patients choose their surgeon [4]. In another study, previous personal experiences in the hospital were the most frequently stated criterion, followed by the hospital's reputation, recommendation from one's own outpatient caregivers, distance from home and recommendations from relatives [5].…”

An online card‐sorting study to inform the initial low‐fidelity design of a crowdsourced health information system for individuals who have chronic health conditions seeking local health‐related resources

“…A nationally representative survey of U.S. adults revealed that 85% of respondents reported that WOM recommendations from family or friends were a very important or at least somewhat important factor when choosing their physician (Hanauer, Zheng, Singer, Gebremariam, & Davis, ). Similar studies have also demonstrated the importance of WOM recommendations when choosing hospitals (De Cruppé & Geraedts, ; Martin, ); primary care physicians (Tu & Lauer, ); surgeons (Yahanda, Lafaro, Spolverato, & Pawlik, ); cancer specialists (Jiang et al, ); and other types of healthcare providers and resources (McCaughey, McGhan, Walsh, Rathert, & Belue, ; Pettigrew & Durrance, ; Shreffler‐Grant, Weinert, Nichols, & Ide, ). Individuals can draw out highly experiential insights from their family, friends and acquaintances around their satisfaction and dissatisfaction on a wide array of points of care, such as cost, clinical competencies, staff members' interpersonal skills, and more (Martin, ).…”

Objektive oder subjektive Qualität?

“…Dazu gehört sicherlich auch eine entsprechende Information der einweisenden Ärzte, die als persönliche Informationslieferanten Nr. 1 der Patienten fungieren [25,26]. Die oft nicht aktuellen Qualitätsberichte der Krankenhäuser gefüllt mit komplizierten Fakten ohne ausreichende Erläuterungen und Bebilderung, die teilweise auf den klinikeigenen Homepages veröffentlicht werden, zeugen eher davon, dass dieses Instrument von den Krankenhäusern selbst nicht ernst genommen wird.…”