How do patients choose physicians? Evidence from a national survey of enrollees in employment-related health plans.

There is growing awareness of consumer and patient choices and their large impact on the ultimate cost and outcomes of health service use. This can occur directly through decisions to seek care, to comply with prescribed treatment regimens, or indirectly through choice of physicians who make treatment decisions jointly with or on behalf of patients. In theory, patients can play an important role in achieving optimal health by taking an active and informed role in treatment decisions and switching physicians if care is unsatisfactory. There is a wide consensus that the role of consumers in shaping the health care delivery system will expand over time with the recent decline of restrictive forms of managed care and rapid increases in the availability of health care information via the internet (Robinson 2001; Herzlinger 1997). In assessing the potential impact of this enhanced role, it is important to understand the process by which consumers evaluate and choose health care providers and treatments. Of particular importance is a better understanding of the role of health status in the consumer choice process. Individuals in poor health use the health care delivery system more frequently and intensively compared with their healthier counterparts. To the extent that providers compete to maintain and attract new patients, provider and treatment choices made by individuals in poor health will have a disproportionate effect on care processes. Likewise, those in poor health will experience disproportionate health and financial consequences of a consumer-driven health care system. This paper contributes to a greater understanding of the consumer choice process by examining patient choice of physician. Patients choose a practitioner each time they seek physician care. Sometimes the choice of a practitioner is explicit, for example, when a patient moves to a new area or chooses to leave an established relationship to join a health plan unaffiliated with his or her physician. Other times the choice is implicit, as in the case of a patient who continues to see the same physician or accepts a referral to a single physician without actively considering alternative practitioners. Literature suggests that patients do not engage in rational or “consumerist” behavior when searching for or choosing physicians. They instead rely heavily on recommendations from family and friends and engage in limited searches for alternative physicians (Hoerger and Howard 1995; Kaiser Family Foundation/Agency for Health Care Policy and Research 1996; Kaiser Family Foundation Agency for Health Care Research and Quality 2000; Lupton, Donaldson, and Lloyd 1997). The increasing availability of information with which to evaluate physician quality has the potential to make the process of choosing physicians more active by reducing the cost and time needed to assess the costs and benefits of seeking care from alternative practitioners. Little is known about the process by which patients search for and choose physicians. Studies to date have focused narrowly on the impact of physician attributes (e.g., gender, race, cost, specialty) (Saha et al. 2000; Weiss and Blustein 1996; Phillips and Brooks 1998; Kerssens, Bensing, and Andela 1997; Marquis 1984). The small number of studies focusing more generally on the choice process use highly selected samples of patients or data from a single geographic region or population subgroup (Hoerger and Howard, 1995; Lupton, Donaldson, and Lloyd 1997; Hibbard and Weeks 1987; Olsen, Kane, and Kasteler 1976; Booth and Babchuk 1972). This paper addresses this gap in the literature by examining several aspects of the process by which patients search for and choose physicians, using data from a survey administered to a random sample drawn from a nationally representative panel of households. Specifically, this study uses a wide range of patient characteristics to predict (1) the use of information to support the choice of current physician, (2) the serious consideration of another doctor prior to choosing a physician, and (3) the stated willingness to switch physicians when presented with information that suggests other health plan physicians received higher quality ratings.