Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
Health Policy. 2017 Oct;121(10):1040-1046. doi: 10.1016/j.healthpol.2017.08.004. Epub 2017 Aug 10.
In Germany, the patient himself makes the choice for or against a health service provider. Hospital comparison websites offer him possibilities to inform himself before choosing. However, it remains unclear, how health care consumers use those websites, and there is little information about how preferences in hospital choice differ interpersonally. We conducted a Discrete-Choice-Experiment (DCE) on hospital choice with 1500 randomly selected participants (age 40-70) in three different German cities selecting four attributes for hospital vignettes. The analysis of the study draws on multilevel mixed effects logit regression analyses with the dependent variables: "chance to select a hospital" and "choice confidence". Subsequently, we performed a Latent-Class-Analysis to uncover consumer segments with distinct preferences. 590 of the questionnaires were evaluable. All four attributes of the hospital vignettes have a significant impact on hospital choice. The attribute "complication rate" exerts the highest impact on consumers' decisions and reported choice confidence. Latent-Class-Analysis results in one dominant consumer segment that considered the complication rate the most important decision criterion. Using DCE, we were able to show that the complication rate is an important trusted criterion in hospital choice to a large group of consumers. Our study supports current governmental efforts in Germany to concentrate the provision of specialized health care services. We suggest further national and cross-national research on the topic.
在德国，患者本人可以选择接受或拒绝医疗服务提供者。医院比较网站为他提供了在选择前了解信息的可能性。然而，目前尚不清楚医疗保健消费者如何使用这些网站，也几乎没有关于医院选择偏好在人际之间差异的信息。我们在三个不同的德国城市进行了一项关于医院选择的离散选择实验（DCE），随机选择了 1500 名年龄在 40-70 岁之间的参与者，为医院案例选择了四个属性。该研究的分析基于多层次混合效应逻辑回归分析，因变量为“选择医院的机会”和“选择信心”。随后，我们进行了潜在类别分析，以揭示具有不同偏好的消费者群体。其中 590 份问卷是可评估的。医院案例的所有四个属性对医院选择都有显著影响。“并发症发生率”这一属性对消费者的决策和报告的选择信心产生了最大的影响。潜在类别分析结果表明，一个占主导地位的消费者群体认为并发症发生率是医院选择的最重要决策标准。通过使用 DCE，我们能够表明，并发症发生率是一个重要的受信任标准，在很大一部分消费者中对医院选择有影响。我们的研究支持德国政府目前在集中提供专门医疗服务方面的努力。我们建议在该主题上进行更多的国家和跨国研究。
