How do patients choose physicians? Evidence from a national survey of enrollees in employment-related health plans.

Abstract

This study examines the process by which patients search for and choose physicians. 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. 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. 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. 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.