Information Asymmetry and Hospital Selection -- The case of 3 surgeries among medical staffs and families
Date Issued
2011
Date
2011
Author(s)
Lee, Tsung-Ching
Abstract
Introduction: Because of the establishment of National Health Insurance and the high population density and convenient communications, out-of-pocket payment and geographical accessibility are no longer major obstacles for the public to gain high-quality medical service in Taiwan. Therefore, the obstacle resulting from information asymmetry becomes a very important policy issue today.
Literature Review: International and local references both indicate: 1. Because of information asymmetry, the public is eager to obtain convenience medical quality indicators; 2. The volume-outcome effect has been well-established; 3. Informed consumers do have different patterns of their consumption of medical service. However, studies on information asymmetry rarely focus on the provider selection behavior of informed consumers.
Methods and Subjects: This study is a secondary and cross-sectional study based on cases of PTCA, CABG, and TKR surgeries of NHI database between 1998 and 2006. This study uses the “o_code” of the “DO” dataset to define surgical cases.
Result: 1. In PTCA, the odds ratio (OR) for informed consumers to choose high-volume hospitals is 1.079 (p=0.364). In CABG, the OR is 1.373 (p=0.0442). In TKR, the OR is 1.458 (p=0.0194). 2. In PTCA, the OR for informed consumers to choose high-volume surgeons is 1.023 (p=0.7704). In CABG the OR is 1.320 (p=0.0719). In TKR, the OR is 1.222 (p=0.1780).
Discussion: Comparative study between 3 surgeries reveals that informed consumers do have higher possibility to choose high-volume hospitals but not high-volume surgeons, probably because the three surgeries are relatively routine surgeries and thus the experience of the hospital staffs as a whole plays a more important role in the determination of surgical outcomes. This study also reveals that in surgeries with higher urgency, informed consumers are less likely to choose high-volume hospitals due to temporal and geographical limitations. On the contrary, in surgeries with lower urgency, informed consumers have higher OR to choose high-volume hospitals.
Conclusion and Policy Implication: Informed consumers do choose high-volume hospitals given volume-outcome effect well-established. Therefore, the different provider-selection pattern of informed consumers is worth researching and might be important in designing medical quality indicators.
Subjects
information asymmetry
volume-outcome effect
informed consumer
provider selection
medical quality indicators
urgency of surgery
Type
thesis
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