Choice Of Health Care Provider Research Articles

In Search of Healing Between Two Worlds: The Use of Traditional and Modern Health Services by Older Women in Rural Bangladesh

The objective of this study is to gain a deeper understanding of the use of traditional and modern medicine among older adult women living in rural Bangladesh. Factors are identified that guide the women's decisions about who to seek help from when they are ill. The findings provide evidence that, in spite of the availability of modern health care, traditional healers— faith-based and herbalists—are widely utilized. Reasons given for their choice of health care providers fall into two categories: belief in the effectiveness of the intervention and service delivery considerations. These data suggest that use of traditional healers persists among women in rural areas of Bangladesh and that health policy should be developed with an acknowledgment of these health practices.

Factors influencing medical institution selection for outpatient services

This study analyzes determinants of patients' choice of healthcare providers in outpatient services and identifies their effects. Data were collected from two waves of the Korean Health Panel. The unit of analysis was an outpatient visit (n=189,739). Various types of medical institutions were groupe...

Childbirth Education and Obstetric Interventions Among Low-Risk Canadian Women: Is There a Connection?

The objective of this study was to examine the associations between attendance at childbirth education classes and maternal characteristics (age, income, educational level, single parent status), maternal psychological states (fear of birth, anxiety), rates of obstetric interventions, and breastfeeding initiation. Between women's 35th and 39th weeks of gestation, we collected survey data about their childbirth fear, anxiety, attendance at childbirth education classes, choice of health-care provider, and expectations for interventions; we then linked women's responses (n = 624) to their intrapartum records obtained through Perinatal Services British Columbia. Older, more educated, and nulliparous women were more likely to attend childbirth education classes than younger, less educated, and multiparous women. Attending prenatal education classes was associated with higher rates of vaginal births among women in the study sample. Rates of labor induction and augmentation and use of epidural anesthesia were not significantly associated with attendance at childbirth education classes. Future studies might explore the effect of specialized education programs on rates of interventions during labor and mode of birth.

Testing the WHO responsiveness concept in the Iranian mental healthcare system: a qualitative study of service users.

BackgroundIndividuals' experience of interacting with the healthcare system has significant impact on their overall health and well-being. To relate patients' experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This study aimed to assess if the WHO responsiveness concept reflected the non-medical expectations of mental healthcare users in Teheran.MethodsIn this qualitative study, four mixed focus group discussions were formed, comprising 53 mental health service users in Tehran, Iran, in 2010. Content analysis was performed for data analysis. Responses were examined in relation to the eight domains of the WHO's responsiveness model.ResultsThere were many commonalities between the findings of this study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from our findings. In addition, the domain of prompt attention was included in two new labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity and confidentiality were considered to be important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however.ConclusionsThe results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in Iran. These findings might help policy-makers' better understanding of what is useful for the improvement of mental health services.

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found.One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking.

PHP3 Patient Preferences Considering the Choice of Health Care Providers in Hungary – Results From Discrete Choice Experiment

PHP3 Patient Preferences Considering the Choice of Health Care Providers in Hungary – Results From Discrete Choice Experiment

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

BackgroundResearch on patients' choice of hospital has focused on inpatients' rather than outpatients' choice of provider. We have investigated Danish outpatients' awareness and utilisation of freedom of choice of provider; which factors influence outpatients' choice of hospital, and how socio-demographic variables influence these factors in a single uptake area, where patients were free to choose any public hospital, where care was provided free at the point of delivery, and where distance to the closest hospitals were short by international standards.MethodsRetrospective questionnaire study of 4,232 outpatients referred to examination, treatment, or follow-up at one of nine somatic outpatient clinics in Roskilde County in two months of 2002, who had not been hospitalised within the latest 12 months. The patients were asked, whether they were aware of and utilised freedom of choice of hospital.ResultsFifty-four percent (2,272 patients) filled in and returned the questionnaire. Forty-one percent of respondents were aware of their right to choose, and 53% of those patients utilised their right to choose. Awareness of freedom of choice of provider was reported to be especially high in female outpatients, patients with longer education, salaried employees in the public sector, and in patients referred to surgical specialties. Female outpatients and students were especially likely to report that they utilised their right to choose the provider. Short distance was the most important reason for outpatients' choice, followed by the GP's recommendations, short waiting time, and the patient's previous experience with the hospital.ConclusionsOutpatients' awareness and utilisation of free choice of health care provider was low. Awareness of freedom of choice of provider differed significantly by specialty and patient's gender, education and employment. Female patients and students were especially likely to choose the clinic by themselves. Most outpatients chose the clinic closest to their home, the GP's recommendation and short waiting time being the second and third most important factors behind choice.

Decision support systems for choosing a primary health care provider in Sweden

ObjectiveTo evaluate how patients are supported with information and other forms of Web-based decision support for making an informed choice of a primary health care provider. MethodsThe article is based on a comparative case study of recently developed tools provided by Web portals in Sweden (one national, three regional). The theoretical framework for analysis is the general calculation model, including the steps of isolating, examining, and ranking available options. ResultsThe provision of information and other forms of support is reasonable when it comes to isolating a particular alternative or presenting a general view of alternatives. As for examining and ranking, one regional system and one national system offer support based on information from patient surveys and waiting times, and one regional system offers support based on provider competencies. ConclusionOne design alternative is to represent the opinions of patients about care centers, another is to represent the characteristics of care centers, and a third is to combine the two. The general calculation model is relevant as a framework for analysis from a practical as well as a theoretical viewpoint. Practical implicationsThe study provides practical examples of decision support for patient choice in primary health care.

Comparison of trust in public vs private health care providers in rural Cambodia

How trust in providers affects health care-seeking behaviour is not well understood. Focus groups and household surveys were conducted in Cambodia to examine how villagers describe their trust in public and private providers, and to assess whether a difference exists in provider trust levels. Our findings suggest the reasons for trusting public and private providers differ, and that villagers' trust in and relationship with providers is one of the important considerations affecting where they seek care. People believed that public providers were 'honest' and 'sincere', did not 'bad mouth people' and explained the 'status of [the] disease'. Villagers trusted public providers for their skills and abilities, and for an effective referral system. In contrast, respondents noted that seeing private providers was 'comfortable and easy', that they 'come to our home' and patients can 'owe [them] some money'. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact. Among those who sought care in the past 30 days, trust in the health care provider was listed as the fifth and second most important consideration for choosing public or private providers, respectively. This study illustrates the importance of trust as a unique concept that can affect people's choice of health care providers in a low-income country.

Impact of comorbidity on the individual's choice of primary health care provider

Objective. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting. The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects. A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. Main outcome measures. The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. Results. Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. Conclusions. This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC.

Choice of providers for treating a neglected tropical disease: an empirical analysis of kala azar in Nepal

Objective To examine the choice of healthcare providers for treating kala azar (KA) in Nepal. Methods Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts. The survey collected information from more than 25 percent of total KA cases in the country. For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider, a multinomial logit model was defined with five alternative options with self care as the reference category. Results The empirical model found that price of medical care services, income of households, knowledge of patients on KA and KA treatment, borrowing money, age of patient, perceived quality of provider types, etc. determine the likelihood of seeking care from the alternative options considered in the analysis. All variables have expected signs and are consistent with earlier studies. The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes, even for a severe disease like KA. Using the empirical models, we have analyzed two policy instruments: demand side financing and interventions to improve the knowledge index about KA. Conclusions Due to high price elasticity of KA care and high spillover effects of KA on the society, policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.

Factors associated with the hypertension outpatients' choice of healthcare providers in Korea

T study was performed to identify hypertension outpatients' motivations in choosing healthcare providers i.e. tertiary hospitals, general hospitals (number of bed is more than or equal to 100), hospitals (number of bed is more than or equal to 30), and clinics for their care management and find the determinants influencing on their choice of healthcare providers. The unit of analysis was a hypertension outpatient visit (n=11,046). The χ2-test was performed to find the differences in choices of healthcare providers by patient characteristics. Additionally, ANOVA was employed to identify differences in out-of-pocket medical and medication costs by the type of provider. The 4 types of healthcare providers were then categorized into two levels (1=hospitals, 2=clinics), and finally, logistic regression analysis was performed to find factors influencing the patients' clinic visit for their care. Of the 11,046 cases, 82.9 percent of patients visited clinics for their care. The medical and medication out-of-pocket costs per case were the highest among the tertiary hospitals followed by general hospitals, hospitals, and clinics. Lower income and less education were associated with a higher frequency of clinic visits. The patients with National Health Insurance were more likely to visit clinics for their care than medicaid patients. Patients with any co-morbidity or disability were more likely to visit hospitals than patients without them. Patients taking any medical test were more likely to visit hospitals than those who were not. Patients with a medication prescription were more likely to visit clinics than those without. Not only for cost-containment to maintain a sound healthcare financing system, but also to reduce the burden of hypertension patients' out-of-pocket costs, policy-makers should pay more attention to encouraging chronic patients to visit clinics rather than hospitals for their care management.

Impact of Increased Economic Burden Due to Human Echinococcosis in an Underdeveloped Rural Community of the People's Republic of China

BackgroundNingxia is located in western People's Republic of China, which is hyperendemic for human cystic echinococcosis (CE) throughout the entire area with alveolar echinococcosis (AE) hyperendemic in the south. This is in part due to its underdeveloped economy. Despite the recent rapid growth in P.R. China's economy, medical expenditure for hospitalization of echinococcosis cases has become one of the major poverty generators in rural Ningxia, resulting in a significant social problem.Methodology/Principal FindingsWe reviewed the 2000 inpatient records with liver CE in surgical departments of hospitals from north, central and south Ningxia for the period 1996–2002. We carried out an analysis of health care expenditure of inpatient treatment in public hospitals, and examined the financial inequalities relating to human echinococcosis and the variation in per capita income between various socioeconomic groups with different levels of gross domestic product for different years. Hospital charges for Yinchuan, NHAR's capital city in the north, increased approximately 35-fold more than the annual income of rural farmers with the result that they preferred to seek health care in local county hospitals, despite higher quality and more efficient treatment and diagnosis available in the city. Household income levels thus strongly influenced the choice of health care provider and the additional expense impeded access of poor people to better quality treatment.Conclusions/SignificanceInformation on socioeconomic problems arising from echinococcosis, which adds considerably to the burden on patient families and communities, needs to be collected as a prerequisite for developing policies to tackle the disease in rural Ningxia.

Healthcare Provider Choice

Healthcare Provider Choice

Factors determining choice of health care provider in Jordan

This paper examines factors influencing a patient's choice of provider for outpatient health care services in Jordan. Factors including demographic, socioeconomic, insurance status, quality of care, household size and cost of health care were studied using a multinomial logit model applied to a sample of 1031 outpatients from the Jordan heathcare utilization and expenditure survey, 2000. The patient's socioeconomic and demographic characteristics affected provider choice. Insurance was not statistically significant in choosing Ministry of Health facilities over other providers. Patients utilizing the public sector were price sensitive, and therefore any attempt to improve accessibility to health care services in Jordan should take this into consideration.

Determinants of health care demand in poor, rural China: the case of Gansu Province

This paper examines the determinants that influence health care demand decisions in rural areas of Gansu province, China. This represents the first effort to identify and quantify the effect of price of care on choice of provider in China, and is the first quantitative examination of this topic focusing on poor rural areas in China. In the three-tier health care system in rural China, we further distinguish the public village clinics and private village clinics using a mixed multinomial logit model. The results show that price and distance play significant roles in choice of health care provider. The price elasticity of demand for outpatients is higher for low-income groups than for high-income groups. When outpatients have particular concerns about provider quality or reputation, or when their health status is poor, distance tends to matter less, i.e. they are willing to travel further in order to obtain better treatment for their illness. Insurance status has a significant impact on the choice of public village clinics relative to self-treatment. Furthermore, age and the attributes of illness are also statistically significant factors. We discuss the policy implications of the results for meeting the health care needs of the poor in rural China.

Quality and Consumer Decision Making in the Market for Health Insurance and Health Care Services

This article reviews the literature relating quality to consumer choice of health plan or health care provider. Evidence suggests that consumers tend to choose better performing health plans and providers and are responsive to initiatives that provide quality information. The response to quality and quality information differs significantly among consumers and across population subgroups. As such the effect of quality information on choice is apparent in only a relatively small, though perhaps consequential, number of consumers. Despite the wealth of findings on the topic to date, the authors suggest directions for future work, including better assessment of the dynamic issues related to information release, as well as a better understanding of how the response to information varies across different groups of patients.

Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

BackgroundUganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors.MethodsSecondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models.ResultsThe odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP.ConclusionAlthough overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and rural populations. Public private partnerships should be broadened to increase access to health services among the vulnerable.

Gender Preference for a Female Physician Diminishes as Women Have Increased Experience With Intimate Examinations

ObjectivesTo determine the importance of seven statements encouraging medical student participation in the health care team with respect to the effect they would have on a woman’s decision to allow a medical student to participate in an intimate physical examination, and to explore factors associated with gender bias. MethodsQuestionnaires were administered to women attending outpatient clinics in obstetrics and gynaecology at Kingston General Hospital and to students at two local secondary schools. ResultsResponses from 683 clinic patients and 192 secondary school students were analyzed. The mean age (range) was 42 years (17- 85) and 16 years (15- 22) for the respective samples. More clinic patients rated each of the statements as important or very important than did students (P < 0.01, Fisher exact tests). The largest differences between the sample groups were seen for the statements pertaining to the potential for enhanced understanding (81.0% vs. 60.2%), quality of health care (87.4% vs. 69.8%), and affording medical students the opportunity to participate (92.7% vs. 77.0%); 72.8% (485/666) of clinic patients reported they would accept an intimate examination by a medical student of either gender, compared with 32.1% (61/190) of secondary school students, and 22.2% (148/666) of clinic patients indicated they would only accept a female student compared with 55.3% (105/190) of secondary school students. The proportion of students preferring female medical students was inversely related to the number of previous breast or pelvic examinations (P = 0.031, chi-square test for trend). ConclusionsEducational statements designed to encourage women to allow students to participate in their medical care had less effect on the secondary school students than on the women in a clinic setting. Although secondary school students express a preference for female physicians, it appears that with increasing experience with intimate examinations other factors take precedence in determining choice of health care provider.

Ethnicity and utilization of family physicians: A case study of Mainland Chinese immigrants in Toronto, Canada

This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants – the most important source of immigrants to Canada since 1996 – in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations.