I recently needed two procedures at an ambulatory surgery center. I used a service that negotiated my price so I could compare costs. Some hospitals were more expensive than others, while some were farther away. The cheapest one was about 60 miles away but required an initial visit that cost extra, while one 20 miles away was more expensive but included the initial visit. Some that were 5-to-10 miles away did not require an initial visit but were more costly. As part of the process, I also had to select a doctor. I ended up selecting a doctor and hospital that were about 20 miles away. There were closer facilities, but the combination of doctor, hospital location and price influenced my decision.
More than one-third of health care spending is inpatient care within hospitals. When patients enter the hospital, they only bear about 3% of the cost. As a result, patients have little reason to select a hospital across town in hopes of saving a few hundred dollars on a hospital stay. In addition, patients do not want to be in the hospital too far from home. Thus, hospitals do not compete with other hospitals on price. So how do patients select hospitals? A recent U.S. News survey of patients found that:
When patients and their loved ones are researching a new health issue, a majority (53%) select a hospital first or select a hospital and a doctor at the same time.
20% of respondents would even switch providers in order to receive care in the hospital they prefer.
80% of patients choose to stay with the doctor and use the doctor’s affiliated hospital, rather than switching doctors.
47% reported selecting their doctor first before considering a hospital.
It is relatively common for primary care providers to make referrals to specialists they know and respect. However, I’ve been involved in situations where a physician suggested seeing a specialist but did not make a recommendation expecting me to decide on one. More from U.S. News:
For instance, a patient might receive a referral from a doctor to see a specialist at a hospital, but they can also find doctors on social media who treat their condition, read about clinicians on hospital-run websites and health insurance directories, and use U.S. News Best Hospitals, an independent ranking of hospitals that also highlights the doctors affiliated with that hospital.
When seeking healthcare, people often must balance practical and logistical needs with wanting a trusted and safe choice, making the search for the “right” hospital or doctor a multilayered decision-making process.
I have always assumed that most patients select a hospital based on their doctor’s preferences. The data bears this out. If your doctor says you need surgery, you are likely to get it at the facility where he has privileges. You are unlikely to dump him and find a new doctor just to go to a different hospital. Oddly enough, a few years ago a small specialty hospital was built across the street from my old office building. It was small and unaffiliated with most insurance plans. The physician investors’ business model was that patients would be willing to pay extra to have surgery there. Then Obamacare happened. Networks got narrower and no longer reimbursed out of network hospitals. The hospital went bankrupt and was sold to a large hospital system. Come to find out patients were not willing to pay that much extra just to stay with their doctors and get care in an exclusive hospital.
What do patients look for in hospitals according to U.S. News:
Cleanliness/tidiness (Visible lack of clutter, clean floors) 51%
Technology/equipment (Modern-looking, well-maintained equipment) 36%
Staff appearance (Professional attire, calm and focused behavior) 35%
Nearly two-thirds (62%) said location is very important for routine care but for complex specialty care, more than one-third (36%) are willing to drive more than three hours.
When choosing doctors, patients most value clinical expertise (22%), years of experience (17%), location (17%), referral from another physician (17%), patient experience and reviews (10%) and recommendations from friends or family (9%).
The key takeaway from the U.S, News survey:
Healthcare organizations must invest heavily in their clinical staff, given that a majority of patients prioritize established provider trust when making healthcare choices.
Nothing in the U.S. News survey came as a surprise. Patients like convenience but often defer to their doctors, who they choose for a variety of reasons (including convenience) and health plan affiliation. In the future health reform needs to move forward to a system where price is considered. It’s not that hard, it just takes political resolve.
U.S. News Survey: How Patients Choose Hospitals and Doctors: Key Priorities