How Do Patients Choose Physicians? Evidence from a National Survey of Enrollees in Employment‐Related Health Plans

Abstract

Objective. This study examines the process by which patients search for and choose physicians. Data Source. A survey to a random sample of individuals between the ages of 21 and 64 with employer-related health benefits, drawn from a nationally representative panel of households. Study Design. Logit models are used to measure the effect of patient characteristics on the probability of (1) using alternative sources of information to support the choice of a current physician, (2) seriously considering another physician before choosing a current physician, and (3) stating a willingness to switch physicians when information suggests that other health plan doctors receive higher quality ratings. Principal Findings. Although a minority of respondents actively searches for a physician, there appears to be substantial variation in the degree of consumer activism across patient subgroups. Poor health status, higher levels of service use in the past year, and stronger ties to individual physicians are associated with less consumer activism. At the same time, greater levels of consumer activism were found among racial and ethnic minorities, among those who report using information to choose their physicians, and among those who switched physicians as a result of dissatisfaction some time in the past five years. Source of quality information (medical experts versus patient advocates) did not influence stated willingness to switch physicians. Conclusions. Despite predictions of the increasing importance of consumer choice in shaping the health care delivery system, the results largely confirm the image depicted in the previous literature of patients as passive health care consumers of physician services, and highlight the importance of investments in the development of decision support tools in consumer-driven health care systems.Key Words. Consumer choice of physician, patient choice of physician, quality information, doctor-switching, physician-switching, and racial differences There is growing awareness of consumer and patient choices and their large impact on the ultimate cost and outcomes of health service use. This can occur directly through decisions to seek care, to comply with prescribed treatment 711 regimens, or indirectly through choice of physicians who make treatment decisions jointly with or on behalf of patients. In theory, patients can play an important role in achieving optimal health by taking an active and informed role in treatment decisions and switching physicians if care is unsatisfactory. There is a wide consensus that the role of consumers in shaping the health care delivery system will expand over time with the recent decline of restrictive forms of managed care and rapid increases in the availability of health care information via the internet (Robinson 2001;Herzlinger 1997).In assessing the potential impact of this enhanced role, it is important to understand the process by which consumers evaluate and choose health care providers and treatments. Of particular importance is a better understanding ...

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