Patients trust specialists most when it comes to hospital choice


Patients trust their specialist’s opinion more than hospital performance reports to help them select where to have treatment, Australian research suggests.

Public performance reporting (PPR) against 48 indicators, including cancer surgery wait times, is mandatory for public hospitals and voluntary for private hospitals, and is part of a push for greater transparency and quality improvement.

The data is published on the government’s MyHospitals site, while some large private providers also publish their own websites.

In a Melbourne University study, researchers surveyed 228 private patients who had surgery for breast, bowel and lung cancer, to ascertain whether PPR was being used to inform decision making, and how it could be improved.

Most (94%) patients were treated in a private hospital and about half were treated at the hospital of choice, a quarter had no choice and a quarter had no preference.

None of the patients reported that a ‘performance reporting website’ had any bearing on decision-making. Instead, 90% named ‘specialist’ the biggest factor to influence which hospital they went to. This was followed by hospital reputation (24%), distance from home (24%) and own experience (18%).

When asked why they had not used PPR one patient reported: “I was too sick to do any research at the time. I took advice from my specialist”.

Another reported: “We only have a private and public hospital where I live, so choice was limited regardless of the information provided.”

Choice being restricted to the hospital or hospitals where their specialist performed surgery was also a theme, wrote Khic-Hout Prang from the University of Melbourne’s School of Population and Global Health and co-authors in BMJ Open.

Only 8% of patients were aware of the existence of the PPR, yet 71% believed it was “very important” to help choose a hospital.

Respondents wanted surgery costs (59%) reported – a point that the study authors said was important given only 47% of elective surgery is fully covered by private health insurance.

Complications (58%) and recovery success rates (57%) are also to be important areas of information that should be publicly reported.

Almost half wanted reports to include information at an individual clinician-level, something that is done in the US and UK.

There is evidence this has led to improvement in quality of care, however, unintended consequences such as ‘cream skimming; and ‘gaming’ – where specialists avoid treating high risk patients who are likely to have poor outcomes – have also been reported, the authors wrote.

They suggest that in future, PPR be broadened to include “personalised and integrated information on cost and quality of hospitals” to better meet the needs of patients. Some patients expressed concern the data may be unreliable, suggesting a need for more patient education.

“While this study focused on people treated for cancer it has relevance for all consumers of healthcare. Future dissemination of PPR information to patients via specialists and GPs may enable patients to make clinically and financially informed choices with the assistance of their medical doctors,” the study authors said.

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