The impact of patient choice of provider on equity: analysis of a patient survey

摘要

Objectives: To understand the impact on equity of giving patients a choice of provider.nMethods: A postal survey of 5997 patients in four areas of England about choice at their recent referral and,nusing a discrete choice experiment, how they would choose in hypothetical situations. Binary logisticnregression and a series of multinomial and nested logit models were used to analyse the data to discovernwhether patients with particular characteristics were more likely to: think choice is important; be offered anchoice; and, choose a non-local provider.nResults: The response rate was 36%. Choice was more important to older patients aged 51–80 years, patientsnfrom non-white backgrounds, women, those with no qualifications and those with a bad past experience of theirnlocal hospital. There were no significant differences in who was offered a choice in terms of education, age groupnor ethnicity. In both real and hypothetical situations patients with no formal qualifications and those living innurban centres were more likely to choose their local hospital, and patients with a bad or mixed pastnexperience at the local hospital were more likely to choose an alternative. In hypothetical choices those whondo not normally travel by car and without Internet access were more likely to choose their local hospitalnirrespective of that hospital’s characteristics.nConclusions: More educated, affluent patients were no more likely to be offered a choice than other populationngroups, but there does appear to be a social gradient in who chose to travel beyond the local area for treatment. Ifnthese results were replicated across England, there is at least the potential risk that when local hospitals arenfailing, patient choice could result in inequitable access to high quality care, rather than enhancing equity asnthe policy’s architects had hoped.