Netherlands Bureau for Economic Policy Analysis (CPB), Den Haag, The Netherlands.
Tilburg University (TiU), Tilburg, The Netherlands.
Int J Health Policy Manag. 2018 Dec 1;7(12):1120-1129. doi: 10.15171/ijhpm.2018.77.
Transparency in quality of care is an increasingly important issue in healthcare. In many international healthcare systems, transparency in quality is crucial for health insurers when purchasing care on behalf of their consumers, for providers to improve the quality of care (if necessary), and for consumers to choose their provider in case treatment is needed. Conscious consumer choices incentivize healthcare providers to deliver better quality of care. This paper studies the impact of quality on patient volume and hospital choice, and more specifically whether high quality providers are able to attract more patients.
The dataset covers the period 2006-2011 and includes all patients who underwent a cataract treatment in the Netherlands. We first estimate the impact of quality on volume using a simple ordinary least squares (OLS), second we use a mixed logit to determine how patients make trade-offs between quality, distance and waiting time in provider choice.
At the aggregate-level we find that, a one-point quality increase, on a scale of one to a hundred, raises patient volume for the average hospital by 2-4 percent. This effect is mainly driven by the hospital with the highest quality score: the effect halves after excluding this hospital from the dataset. Also at the individual-level, all else being equal, patients have a stronger preference for the hospital with the highest quality score, and appear indifferent between the remaining hospitals.
Our results suggest that the top performing hospital is able to attract significantly more patients than the remaining hospitals. We find some evidence that a small share of consumers may respond to quality differences, thereby contributing to incentives for providers to invest in quality and for insurers to take quality into account in the purchasing strategy.
医疗保健领域的服务质量透明度是一个日益重要的问题。在许多国际医疗保健系统中，质量透明度对于代表消费者购买服务的健康保险公司、改善服务质量（如有必要）的服务提供商以及在需要治疗时选择服务提供商的消费者而言至关重要。有意识的消费者选择激励医疗保健提供商提供更好的服务质量。本文研究了质量对患者数量和医院选择的影响，更具体地说，是高质量的提供商是否能够吸引更多的患者。
该数据集涵盖了 2006 年至 2011 年期间，包括在荷兰接受白内障治疗的所有患者。我们首先使用简单的普通最小二乘法（OLS）来估计质量对数量的影响，其次使用混合逻辑回归来确定患者在提供商选择中如何在质量、距离和等待时间之间进行权衡。
在总体水平上，我们发现，质量评分提高一个单位（满分 100 分）会使平均医院的患者数量增加 2-4%。这种效应主要是由质量评分最高的医院驱动的：将该医院从数据集中排除后，效应减半。同样在个体水平上，在其他条件相同的情况下，患者对质量评分最高的医院有更强的偏好，并且对其余医院表现出漠不关心。
我们的结果表明，表现最好的医院能够吸引明显更多的患者，而其余医院则无法做到这一点。我们发现一些证据表明，一小部分消费者可能会对质量差异做出反应，从而为提供商投资质量提供激励，并为保险公司在购买策略中考虑质量提供依据。
