Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany

Avdic, Daniel; Moscelli, Giuseppe; Pilny, Adam; Sriubaite, Ieva

doi:10.1016/j.jhealeco.2019.102229

Cited by 34 publications

(30 citation statements)

References 43 publications

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“…41 Avdic et al believed that patient satisfaction scores might be an important complement to clinical indicators. 42 Combined with EPHS, because the long-term services and outcomes are susceptible to multiple factors, using one-year objective indicators is likely to be highly endogenous. Generally, awareness rate or satisfaction rates are often used as indicators to evaluate the quality of EPHS, but these two indicators are still not comprehensive.…”

Section: Outputs Indicatorsmentioning

confidence: 99%

“…However, Pérotin et al found in the study on the quality of the service of hospitals of different ownership that the difference in the average quality level of different types of medical institutions is entirely attributable to the characteristics of patients 41 . Avdic et al believed that patient satisfaction scores might be an important complement to clinical indicators 42 . Combined with EPHS, because the long‐term services and outcomes are susceptible to multiple factors, using one‐year objective indicators is likely to be highly endogenous.…”

Section: Empirical Strategymentioning

confidence: 99%

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Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

Yuan

Hou

2020

Health Planning & Management

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Background: Essential public health services (EPHS) is general welfare public health interventions led by the Chinese government and provided by the primary medical institutions to all residents. In Beilin District, Xi'an, EPHS producers can be divided into outsourced institutions and public institutions. Objective: Can outsourcing EPHS reduce costs and improve efficiency and quality? There is still no definite answer to this question. This paper compares the performance of outsourced institutions and public institutions in terms of efficiency and quality, explains the reasons for this phenomenon. Methods: This paper uses a theoretical and two-stage DEA model Based on a "triple subject" research framework. Results: The results show that the difference between public institutions and outsourced institutions is mainly reflected in service quality. When the quality is not measured, outsourced institutions' production efficiency is higher than that of public institutions. When there are quality measurements, the production efficiency of outsourced institutions is lower than that of public institutions. Conclusions: Outsourced institutions perform worse than public institutions. The reason is that a bilateral monopolistic market structure has formed between local governments and outsourced institutions. This situation makes it difficult for the government to replace poor quality outsourced institutions under the constraints of a limited budget.

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Section: Outputs Indicatorsmentioning

confidence: 99%

Section: Empirical Strategymentioning

confidence: 99%

Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

Yuan

Hou

2020

Health Planning & Management

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show abstract

“…Several studies investigate objective clinical outcome indicators such as mortality, revision, readmission and re-operation rates; the selection of indicators being based on the procedure and data availability [5,[14][15][16][17][18]. Additionally, literature on patients' hospital choice covers the impact of subjective quality indicators such as hospital reputation based on patient experience questionnaires [17,19,20] or on hospital reputation according to physicians' opinions [9]. With the emergence of patient-reported outcome measures (PROMs) in recent years, first studies examine the influence of changes of PROM scores on hospital choice [21].…”

Section: Introductionmentioning

confidence: 99%

The impact of quality on hospital choice. Which information affects patients’ behavior for colorectal resection or knee replacement?

Kuklinski

Vogel

Geißler

2021

Health Care Manag Sci

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Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients’ hospital choice. We use data from ~145,000 German patients and ~ 900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients’ marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to be present. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients’ hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns.

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“…However, there is limited evidence about how internet affects adult hospital choices. When it comes to the factors influencing residents’ choice of medical treatment, most previous studies have focused more on hospital-related factors, including hospital equipment, distance, time, cost, reputation, doctor level, etc [ 17 - 22 ]. A survey showed that the primary reasons for choosing private hospitals were the presence of a specialist, availability of good equipment and technology, and trust in treatment, whereas proximity, receiving enough information, and being well-treated were the reasons why participants chose family health centers in Samsun Province in Turkey [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis

Ma¹,

Sun²,

Cui³

et al. 2020

J Med Internet Res

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Background The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. Objective The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. Methods With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. Results Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults’ medical decisions. Conclusions Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents’ cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.

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Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany

Cited by 34 publications

References 43 publications

Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

The impact of quality on hospital choice. Which information affects patients’ behavior for colorectal resection or knee replacement?

Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis

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