Patient preferences, referral process, and access to specialized care. Is patient choice constrained?

In most developed countries, patients have been encouraged to elect their preferred choice of health care provider. However, this is different for specialized care, where the patient's referral could be defined as a two-stage decision process and their options are pre-selected by their general...

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Bibliographic Details
Published in:Applied economics 2024-02, Vol.56 (8), p.978-996
Main Authors: Huguet, Marius, Joutard, Xavier, Perrier, Lionel
Format: Article
Language:English
Subjects:
Access to care
Cancer
choice set
consideration set
Decision making models
Developed countries
Economic analysis
Economic theory
Family physicians
Health care
Hospitals
Humanities and Social Sciences
Internalization
Medical personnel
Medical referrals
Patient control
patient preferences
patient referrals
Patients
Quality of care
Revealed preferences
Specialization
Treatment preferences
Waiting times
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Summary:In most developed countries, patients have been encouraged to elect their preferred choice of health care provider. However, this is different for specialized care, where the patient's referral could be defined as a two-stage decision process and their options are pre-selected by their general practitioner (GP). In this study, we estimate patient preferences while controlling for the pre-selection procedure, and we investigate whether patients are actively choosing their provider for cancer care. The French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI - MCO 2017) has been used for investigation. We estimated a multinomial choice model when choice sets are in fact unobserved, which is assumed to identify patient preferences, in a revealed preferences framework. Our findings provide evidence that patients consider factors other than distance to select their provider. The patient - hospital distance as well as the specialization profile of providers appears to be internalized in the pre-selection process, while patients rather consider waiting times, hospital quality, and other provider attributes to make their final choice. We also found that patients would be treated in higher-quality hospitals if they had the opportunity to choose among all available providers.
ISSN:0003-6846
1466-4283
DOI:10.1080/00036846.2023.2288041