Hospital Choice for Cataract Treatments: The Winner Takes Most

Document Type: Original Article

Authors

1 Netherlands Bureau for Economic Policy Analysis (CPB), Den Haag, The Netherlands

2 Tilburg University (TiU), Tilburg, The Netherlands

3 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.

4 Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands

Abstract

Background
Transparency in quality of care is an increasingly important issue in healthcare. In many international healthcare systems, transparency in quality is crucial for health insurers when purchasing care on behalf of their consumers, for providers to improve the quality of care (if necessary), and for consumers to choose their provider in case treatment is needed. Conscious consumer choices incentivize healthcare providers to deliver better quality of care. This paper studies the impact of quality on patient volume and hospital choice, and more specifically whether high quality providers are able to attract more patients.
 
Methods
The dataset covers the period 2006-2011 and includes all patients who underwent a cataract treatment in the Netherlands. We first estimate the impact of quality on volume using a simple ordinary least squares (OLS), second we use a mixed logit to determine how patients make trade-offs between quality, distance and waiting time in provider choice.
 
Results
At the aggregate-level we find that, a one-point quality increase, on a scale of one to a hundred, raises patient volume for the average hospital by 2-4 percent. This effect is mainly driven by the hospital with the highest quality score: the effect halves after excluding this hospital from the dataset. Also at the individual-level, all else being equal, patients have a stronger preference for the hospital with the highest quality score, and appear indifferent between the remaining hospitals.
 
Conclusion
Our results suggest that the top performing hospital is able to attract significantly more patients than the remaining hospitals. We find some evidence that a small share of consumers may respond to quality differences, thereby contributing to incentives for providers to invest in quality and for insurers to take quality into account in the purchasing strategy.

Highlights

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Keywords

Main Subjects


  1. Enthoven AC. Consumer-Choice Health plan (second of two parts). A national-health-insurance proposal based on regulated competition in the private sector. N Engl J Med. 1978;298(13):709-720. doi:10.1056/nejm197803302981304
  2. Kolstad JT, Chernew ME. Quality and consumer decision making in the market for health insurance and health care services. Med Care Res Rev. 2009;66(1 Suppl):28s-52s. doi:10.1177/1077558708325887
  3. Bijlsma M, Pomp M. Via transparantie naar kwaliteit in de ziekenhuiszorg. ESB. 2008;93(4541):486-489.
  4. Pope DG. Reacting to rankings: evidence from "America's Best Hospitals." J Health Econ. 2009;28(6):1154-1165. doi:10.1016/j.jhealeco.2009.08.006
  5. Bundorf MK, Chun N, Goda GS, Kessler DP. Do markets respond to quality information? The case of fertility clinics. J Health Econ. 2009;28(3):718-727. doi:10.1016/j.jhealeco.2009.01.001
  6. Mukamel DB, Weimer DL, Zwanziger J, Gorthy SF, Mushlin AI. Quality report cards, selection of cardiac surgeons, and racial disparities: a study of the publication of the New York State Cardiac Surgery Reports. Inquiry. 2004;41(4):435-446. doi:10.5034/inquiryjrnl_41.4.435
  7. Mennemeyer ST, Morrisey MA, Howard LZ. Death and reputation: how consumers acted upon HCFA mortality information. Inquiry. 1997;34(2):117-128.
  8. Varkevisser M, van der Geest SA, Schut FT. Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands. J Health Econ. 2012;31(2):371-378. doi:10.1016/j.jhealeco.2012.02.001
  9. Jung K, Feldman R, Scanlon D. Where would you go for your next hospitalization? J Health Econ. 2011;30(4):832-841. doi:10.1016/j.jhealeco.2011.05.006
  10. Bitler M, Schmidt L. Health disparities and infertility: impacts of state-level insurance mandates. Fertil Steril. 2006;85(4):858-865. doi:10.1016/j.fertnstert.2005.11.038
  11. Tay A. Assessing competition in hospital care markets: the importance of accounting for quality differentiation. Rand J Econ. 2003;34(4):786-814.
  12. Romano PS, Zhou H. Do well-publicized risk-adjusted outcomes reports affect hospital volume? Med Care. 2004;42(4):367-377.
  13. Howard DH, Kaplan B. Do report cards influence hospital choice? The case of kidney transplantation. Inquiry. 2006;43(2):150-159. doi:10.5034/inquiryjrnl_43.2.150
  14. Gutacker N, Siciliani L, Moscelli G, Gravelle H. Choice of hospital: Which type of quality matters? J Health Econ. 2016;50:230-246. doi:10.1016/j.jhealeco.2016.08.001
  15. Beukers PD, Kemp RG, Varkevisser M. Patient hospital choice for hip replacement: empirical evidence from the Netherlands. Eur J Health Econ. 2014;15(9):927-936. doi:10.1007/s10198-013-0535-7
  16. Keating NL, Kouri EM, He Y, Freedman RA, Volya R, Zaslavsky AM. Location isn't everything: proximity, hospital characteristics, choice of hospital, and disparities for breast cancer surgery patients. Health Serv Res. 2016;51(4):1561-1583. doi:10.1111/1475-6773.12443
  17. Cutler DM, Huckman RS, Landrum MB. The role of information in medical markets: an analysis of publicly reported outcomes in cardiac surgery. Am Econ Rev. 2004;94(2):342-346.
  18. Wang J, Hockenberry J, Chou SY, Yang M. Do bad report cards have consequences? Impacts of publicly reported provider quality information on the CABG market in Pennsylvania. J Health Econ. 2011;30(2):392-407. doi:10.1016/j.jhealeco.2010.11.006
  19. Dranove D, Sfekas A. Start spreading the news: a structural estimate of the effects of New York hospital report cards. J Health Econ. 2008;27(5):1201-1207. doi:10.1016/j.jhealeco.2008.03.001
  20. Cataracts. Emedicinehealth website. Cataracts. http://www.emedicinehealth.com/cataracts/article_em.htm. Published 2014.
  21. Bourne RR, Stevens GA, White RA, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. Lancet Glob Health. 2013;1(6):e339-349. doi:10.1016/s2214-109x(13)70113-x
  22. Resnikoff S, Pascolini D, Etya'ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844-851. doi:10.1590/S0042-96862004001100009
  23. Cataract surgery. NHS website. https://www.nhs.uk/conditions/cataract-surgery/. Published 2016.
  24. Risks of cataract surgery. NHS website. http://www.nhs.uk/Conditions/Cataract-surgery/Pages/Risks.aspx. Published 2012.
  25. Varkevisser M, van der Geest SA. Why do patients bypass the nearest hospital? An empirical analysis for orthopaedic care and neurosurgery in the Netherlands. Eur J Health Econ. 2007;8(3):287-295. doi:10.1007/s10198-006-0035-0
  26. Sivey P. The effect of waiting time and distance on hospital choice for English cataract patients. Health Econ. 2012;21(4):444-456. doi:10.1002/hec.1720
  27. Ketelaar NA, Faber MJ, Flottorp S, Rygh LH, Deane KH, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev. 2011(11):Cd004538. doi:10.1002/14651858.CD004538.pub2
  28. Elsevier. De beste ziekenhuizen. Elsevier; 2011:74-89.
  29. Mainz J. Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care. 2003;15(6):523-530.
  30. Perotin V, Zamora B, Reeves R, Bartlett W, Allen P. Does hospital ownership affect patient experience? An investigation into public-private sector differences in England. J Health Econ. 2013;32(3):633-646. doi:10.1016/j.jhealeco.2013.03.003
  31. Train K. Discrete Choice Methods with Simulation. Cambridge University Press; 2009.
  32. Train K. Discrete Choice Methods with Simulation. Cambridge University Press; 2003.