Beukers Puck D C, Kemp Ron G M, Varkevisser Marco
Performation Healthcare Intelligence B.V., Bilthoven, The Netherlands.
Eur J Health Econ. 2014 Dec;15(9):927-36. doi: 10.1007/s10198-013-0535-7. Epub 2013 Oct 25.
In the Dutch health care system, hospitals are expected to compete. A necessary condition for competition among hospitals is that patients do not automatically choose the nearest hospital, but are-at least to some extent-sensitive to differences in hospital quality. In this study, an analysis is performed on the underlying features of patient hospital choice in a setting where prices do not matter for patients as a result of health insurance coverage. Using claims data from all Dutch hospitals over the years 2008-2010, a conditional logit model examines the relationship between patient characteristics (age, gender and reoperations) and hospital attributes (hospital quality information, waiting times on treatments and travel time for patients to the hospitals) in the market for general non-emergency hip replacement treatments. The results show that travel time is the most important determinant in patient hospital choice. From our analysis, however, it follows that publicly available hospital quality ratings and waiting times also have a significant impact on patient hospital choice. The panel data used for this study (2008-2010) is rather short, which may explain why no coherent and persistent changes in patient hospital choice behaviour over time are found.
在荷兰医疗体系中，医院被期望参与竞争。医院间竞争的一个必要条件是患者不会自动选择最近的医院，而是至少在一定程度上对医院质量差异敏感。在本研究中，针对一种因医疗保险覆盖而价格对患者无关紧要的情形，对患者选择医院的潜在特征进行了分析。利用2008年至2010年荷兰所有医院的理赔数据，一个条件logit模型检验了普通非急诊髋关节置换治疗市场中患者特征（年龄、性别和再次手术情况）与医院属性（医院质量信息、治疗等待时间以及患者前往医院的行程时间）之间的关系。结果表明，行程时间是患者选择医院的最重要决定因素。然而，从我们的分析来看，公开可得的医院质量评级和等待时间对患者选择医院也有显著影响。本研究使用的面板数据（2008 - 2010年）相当短，这或许可以解释为何未发现患者选择医院的行为随时间有连贯且持续的变化。
