Abstract
BackgroundIn recent years, the information environment for patients to learn about physician quality is being rapidly changed by Web-based ratings from both commercial and government efforts. However, little is known about how various types of Web-based ratings affect individuals’ choice of physicians.ObjectiveThe objective of this research was to measure the relative importance of Web-based quality ratings from governmental and commercial agencies on individuals’ choice of primary care physicians.MethodsIn a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and nonclinical aspects of care provided by governmental and commercial agencies.ResultsThe relative log odds of choosing a physician increases by 1.31 (95% CI 1.26-1.37; P<.001) and 1.32 (95% CI 1.27-1.39; P<.001) units when the government clinical ratings and commercial nonclinical ratings move from 2 to 4 stars, respectively. The relative log odds of choosing a physician increases by 1.12 (95% CI 1.07-1.18; P<.001) units when the commercial clinical ratings move from 2 to 4 stars. The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government is 1.03 (95% CI 0.98-1.09; P<.001) units higher than a physician with 2 stars in this rating. The log odds of selecting a physician with 4 stars in nonclinical government ratings relative to a physician with 2 stars is 0.23 (95% CI 0.13-0.33; P<.001) units higher for females compared with males. Similar star increase in nonclinical commercial ratings increases the relative log odds of selecting the physician by female respondents by 0.15 (95% CI 0.04-0.26; P=.006) units.ConclusionsIndividuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government’s perspective.
Highlights
To improve quality, foster competition, promote transparency, and help patients make informed decisions, it is critical for patients to have access to reliable information and make cognizant choices about their medical providers [1,2]
Individuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician
The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government was 1.03 units higher than a physician with 2 stars in this rating
Summary
Foster competition, promote transparency, and help patients make informed decisions, it is critical for patients to have access to reliable information and make cognizant choices about their medical providers [1,2]. The Centers for Medicare and Medicaid Services (CMS) is the most prominent governmental agency in the United States that collects, aggregates, and reports quality measures of different aspects of medical care. Through initiatives such as Hospital Compare [4], CMS reports quality data on both clinical and nonclinical aspects of medical services offered by different providers. In parallel with CMS, private and commercial agencies such as Vitals [5], RateMDs [6], and ProPublica [7] collect and report quality metrics on both clinical and nonclinical aspects of care. Little is known about how various types of Web-based ratings affect individuals’ choice of physicians
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