Themes affecting health-care consumers’ choice of a hospital for elective surgery when receiving web-based comparative consumer information
Introduction
Comparative consumer information (CCI) about quality of care can be used for several purposes, one of which is public reporting [1]. The principal goal of public reporting is to help consumers choose their health-care provider on rational grounds. The underlying assumption is that a rational choice is a good choice. In The Netherlands health-care organizations have started collecting data about their own performance from the consumers perspective [2]. The results are aggregated and published as CCI on a government-sponsored website. This is a recent development based on a revision of the Social Insurance Act. This act introduces quasi-market mechanisms in the health-care system to secure more freedom of choice for consumers.
Selecting a provider, however, is a difficult and complex task [3]. The complexity lies in various aspects of information processing influenced by, e.g., information format, presentation and numeracy literacy [4], [5]. A recent systematic review reported that most studies into CCI and decision making had been conducted in laboratory settings and focused on the choice of health-care plans [6]. The use of CCI in laboratory situations leads to a preference for plans with lower costs, whereas in real-world settings it leads to a preference for plans with higher quality. CCI has been developed for health plans [4], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] and – more recently – for long-term care facilities [24]; CCI for hospitals is still under development [25].
Although there is little empirical evidence about the way consumers choose a hospital when confronted with CCI, there are two dominant theories [19]. The Behavioral Conception Theory considers the decision process to be structured in four stages: (1) awareness of CCI; (2) understanding CCI; (3) appreciating CCI as useful; (4) the decision itself, ideally the choice of provider. This theory assumes that choice is conscious and deliberate and using a set of fixed and ordered criteria. By contrast, the Constructed Preference Theory claims that people's preferences are not created in a steady process, but only elicited during the process of decision making. This process evolves differently each time, in a specific situation, on the spot, by an adaptive decision maker, and is influenced by contextual factors. This raises the question: How do health-care consumers use CCI in their decision-making?
The aim of the current study was to get insights into the decision-making strategies of health-care consumers selecting a hospital for elective surgery when confronted with CCI.
Section snippets
Approach
We designed a qualitative descriptive study. We performed in-depth interviews and focus-group discussions to collect relevant data. Participants had undergone a hip or knee anthroplasty.
We used CCI about hip and knee operations based on the Consumer-Quality-Index questionnaire, which measures the subjective experience of health-care consumers in the Netherlands [27]. The questionnaire is a Dutch version of the Consumer Assessment of Health Plan Survey (CAHPS) [2]. We have chosen CCI for hip and
Results
Table 1 shows that the respondents were predominantly elderly. About two-thirds of them were female and all but one had a lower or intermediate educational level. More than half of the respondents had some previous experience using the internet, while three occasionally received internet support from their children.
The analysis of the individual interviews and focus groups resulted in four themes: decision making, perceived benefits, unmet information needs, and trustworthiness.
Discussion
We studied the decision-making strategies of consumers when confronted with CCI. Although the consumers in our study were well able to understand the information that was presented to them, they had problems applying this information as a decision aid. Sometimes this resulted in “camouflaged decisions”. Other studies have reported similar findings [33], [34], [35]. Hibbard and colleagues relate these problems to the complexity of decision making itself: consumers must be able to process this
Conflict of interest
All authors declare no conflict of interest.
Acknowledgment
This study was funded by a grant from the Netherlands Organisation for Health Research and Development (ZonMw). We would like to thank the respondents who were willing to share their time and thoughts with us. We are grateful to Mrs Elly Stoffers for her support during the recruitment phase, and we thank Bernadette Zinzen, Karin Vaessen and Paddy Hinssen for their administrative support.
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