title: Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients.
abstract: Various north-western European health-care systems encourage patients to make an active choice of health-care provider. This study explores, qualitatively, patients' hospital selection processes and provides insight into the reasons why patients do or do not make active choices.
  
  
  
  Semi-structured individual interviews were conducted with 142 patients in two departments of three Dutch hospitals. Interviews were recorded, transcribed and analysed in accordance with the grounded theory approach.
  
  
  
  Three levels of choice activation were identified - passive, semi-active and active. The majority of the patients, however, visited the default hospital without having used quality information or considered alternatives. Various factors relating to patient, provider and health-care system characteristics were identified that influenced patients' level of choice activation. On the whole, the patients interviewed could be classified into five types with regard to how they chose, or 'ended up at' a hospital. These types varied from patients who did not have a choice to patients who made an active choice.
  
  
  
  A large variation exists in the way patients choose a hospital. However, most patients tend to visit the default without being concerned about choice. Generally, they do not see any reason to choose another hospital. In addition, barriers exist to making choices. The idea of a patient who actively makes a choice originates from neoclassical microeconomic theory. However, policy makers may try in vain to bring principles originating from this theory into health care. Even so, patients do value the opportunity of attending 'their' own hospital.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
authors.forename: Aafke
authors.initials: A
authors.lastname: Victoor
authors.affiliation: Quality Institute of the National Health Care Institute, Diemen, the Netherlands.|'Transparency in Health Care', Tilburg University, Tilburg, the Netherlands.
authors.forename: Diana
authors.initials: D
authors.lastname: Delnoij
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.|'Social Impact of Health Law', Tilburg University, Tilburg, the Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: Friele
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
authors.forename: Jany
authors.initials: J
authors.lastname: Rademakers
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D002755:Choice Behavior; D003695:Delivery of Health Care; D005260:Female; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D011787:Quality of Health Care; D012017:Referral and Consultation
keywords: choice behaviour; hospitals; patient freedom of choice laws; patients; qualitative research; quality of health care