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.
Highlights
In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports
Some integrated care models provide a tight connexion with a specific hospital, especially with hospital owned policlinics, but patients are free to inscribe in such models with mostly a 12-month term of notice
Our study explored four research questions on hospital choice from the patient perspective in the German health system: 1. How many patients decide where to go for hospital treatment?
Summary
In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports. Free choice of healthcare providers, especially of hospitals, is a declared health policy objective in many countries and in Germany as well [1,2,3,4,5,6]. In Germany approximately 2000 hospitals with some 500,000 beds provide hospital care [rehabilitation clinics de Cruppé and Geraedts BMC Health Services Research (2017) 17:720 not included] with the hospitalist model as the standard provision of medical care for inpatients. They treat about 19 million inpatient cases with statutory and private insurance coverage per year [18]. It might occur that a patient is required to pay the transport to a distant hospital
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