Waarom kiezen patiënten niet voor het ‘beste’ ziekenhuis?*

Objective

To gain an insight into how patients end up at a particular hospital and why the hospital selection behaviour of many patients does not match that of the ‘active patient’ that policy makers had in mind when reforming the Dutch healthcare system.

Design

Semi-structured interviews with outpatients in 2 departments of 3 Dutch hospitals.

Method

The interviews were conducted, recorded, transcribed and analysed according to the ‘grounded theory approach’.

Results

In total, 142 interviews were conducted. Three levels of choice activation were identified: ‘passive’, ‘semi-active’ and ‘active’. Passive patients visited the default hospital without having used quality information or considered alternatives, while active patients both used information and considered alternatives. Various factors influenced patients’ level of choice activation. Based on these factors and patients’ level of choice activation, patients could be classified into 5 types, varying from patients who did not have a choice because of their healthcare path, to patients who fit the description of the ‘active patients’ who policy makers had in mind.

Conclusion

A large variation exists in the way patients choose or more passively ‘end up at’ a hospital. However, most of the interviewed patients visited the default option. Patients do not see any reason to actively make a choice or have no idea that they have choice options. The idea of a patient who actively makes a choice originates from the notion of market forces. However, this study shows that these types of principle do not always apply to healthcare. Even so, patients do value the opportunity to be able to choose ‘their’ hospital.

Conflict of interest and financial support: ICMJE forms provided by the authors are available online along with the full text of this article.