Why patients may not exercise their choice when referred for hospital care:An exploratory study based on interviews with patients

Background Various north-western European health-care systems encourage patients to make an active choice of health-care provider. This study explores, qualitatively, patients' hospital selection processes and provides insight into the reasons why patients do or do not make active choices. Methods Semi-structured individual interviews were conducted with 142 patients in two departments of three Dutch hospitals. Interviews were recorded, transcribed and analysed in accordance with the grounded theory approach. Results Three levels of choice activation were identified – passive, semi-active and active. The majority of the patients, however, visited the default hospital without having used quality information or considered alternatives. Various factors relating to patient, provider and health-care system characteristics were identified that influenced patients' level of choice activation. On the whole, the patients interviewed could be classified into five types with regard to how they chose, or ‘ended up at’ a hospital. These types varied from patients who did not have a choice to patients who made an active choice. Conclusions A large variation exists in the way patients choose a hospital. However, most patients tend to visit the default without being concerned about choice. Generally, they do not see any reason to choose another hospital. In addition, barriers exist to making choices. The idea of a patient who actively makes a choice originates from neoclassical microeconomic theory. However, policy makers may try in vain to bring principles originating from this theory into health care. Even so, patients do value the opportunity of attending ‘their’ own hospital

Risk, trust and patients’ strategic choices of healthcare practitioners

Research on patients’ choice of healthcare practitioners has focussed on countries with regulated and controlled healthcare markets. In contrast, low- and middle-income countries have a pluralistic landscape where untrained, unqualified and unlicensed informal healthcare providers (IHPs) provide significant share of services. Using qualitative data from 58 interviews in an Indian village, this paper explores how patients choose between IHPs and qualified practitioners in the public and formal private sectors. The study found that patients’ choices were structurally constrained by accessibility and affordability of care and choosing a practitioner from any sector presented some risk. Negotiation and engagement with risks depended on perceived severity of the health condition and trust in practitioners. Patients had low institutional trust in public and formal private sectors, whereas IHPs operated outside any institutional framework. Consequently, people relied on relational or competence-derived interpersonal trust. Care was sought from formal private practitioners for severe issues due to high-competence-based interpersonal trust in them, whereas for other issues IHPs were preferred due to high relationship-based interpersonal trust. The research shows that patients develop a strategic approach to practitioner choice by using trust to negotiate risks, and crucially, in low- and middle-income countries IHPs bridge a gap by providing accessible and affordable care imbued with relational–interpersonal trust

Comparative Performance Information Plays No Role in the Referral Behaviour of GPs

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients. Method: We used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network. Results: Seventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of- care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI. Conclusion: Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process

Patient Choice in the Post-Semashko Health Care System

The opportunity for patient choice in the health care system in CIS countries was created by the partial destruction of the referral system and the development of paid medical services. The data of two population surveys conducted in Russia in 2009 and 2011 show that patient choice of medical facility and physician is taking place in the post-Semashko health care system, and it is not restricted to the area of paid medical services. However for the majority of population the choice of medical facility and physician is not a necessity. Part of reason for patient choice is caused by the failure of the patient referral system to ensure the necessary treatment. For some Russian citizens, the choice of health care provider is a means to obtain better quality care, and in this respect the enhancement of patient choice is leading to the improved efficiency of the emerging health care system.Была создана возможность для выбора пациента в системе здравоохранения в странах СНГ путем частичного разрушения системы направлений и развития платных медицинских услуг. Данные двух исследований, проведенных в области народонаселения в России в 2009 и 2011 показывают, что выбор медицинского учреждения и врача пациентом происходит в после-семашковской системе здравоохранения, и не ограничивается областью платных медицинских услуг. Однако для большинства населения выбор медицинского учреждения и врача не является необходимостью. Часть причины для выбора пациента вызвано неспособностью пациента реферальной системы в обеспечить необходимое лечение. Для некоторых российских граждан, выбор медицинских услуг является средством для получения лучшего качества медицинской помощи, и в этом отношении поощрение выбора пациента ведет к повышению эффективности создаваемой системы здравоохранения

Informatiebronnen over de langdurige zorg & gemiste informatie.

Zorgkantoren hebben de taak om de langdurige zorg voor Wlz-klanten te regelen door zorg in te kopen en (potentiële) klanten te adviseren. In dit feitenblad staat beschreven van welke bronnen klanten informatie ontvingen over langdurige zorg. Daarnaast tonen we welke informatie door klanten werd gemist toen de zorg moest worden gekozen of aangepast. We onderscheiden bestaande klanten (>6 mnd klant) en nieuwe klanten (<6 mnd klant)

Patiënten zien een toekomst voor een zorgbuddy, zo blijkt uit de resultaten van een pilot.

Uit onderzoek blijkt dat veel patiënten informatie die gegeven wordt tijdens artsenbezoeken voor een groot deel niet onthouden [1]. Een oplossing kan zijn om iemand mee te nemen naar het gesprek die kan helpen met het onthouden van informatie [2]. Coöperatie VGZ (cVGZ), de Radboud Universiteit Nijmegen, het Radboudumc en Westterzijde zijn een pilot gestart waarin geneeskundestudenten als zorgbuddy zijn ingezet om patiënten te ondersteunen tijdens de behandel- of herstelperiode van hun ziekte. Het Nivel heeft de ervaringen van de deelnemende patiënten met de zorgbuddy vervolgens geëvalueerd. Hieruit bleek dat de deelnemers zeker een toekomst zien voor de zorgbuddy. De behoeften van deelnemers rondom de invulling van de rol van de zorgbuddy verschillen echter. Deelnemers zijn het er wel over eens dat het een taak voor de zorgverzekeraar is om een zorgbuddy aan te bieden aan hun verzekerden. Daarnaast vinden zij het van belang voor studenten om ervaring en kennis op te doen over hoe het is om ziek te zijn door tijdens de opleiding een periode de zorgbuddy van een patiënt te zijn. (aut. ref.