gms | German Medical Science

Background: Patients’ choice of a physician is a classical problem of asymmetric information in that patients cannot directly observe the quality of physicians’ medical treatment. To obtain more information about treatment quality, patients can use different sources, ranging from private sources such as friends or other physicians to public sources such as published material. Publication of physician quality information (PQI) can improve transparency among providers, and, thus, foster competition in the healthcare system. Thus, published PQI has the potential to enhance health outcomes by promoting quality improvement and efficient medical care.

Objective: The goal of our study is to contribute to this topic by providing evidence on determinants of PQI use in general as well as by identifying which of the different sources of PQI in the outpatient sector are used by whom.

Methods: We utilize data from the population-based KORA-Fit study in Southern Germany in 2018/19. Our sample includes 53- to 74-year-olds (N=1728). We are thus able to systematically identify factors associated with PQI use for a group of older adults in the outpatient sector. Our empirical analysis consists of a reduced-form binary logistic regression model to estimate determinants of

1.

PQI use,

2.

PQI sources, and

3.

the potential use of a hypothetical statutory PQI source.

To identify determinants, we use a list of potentially important patient characteristics with a specific focus on personal health variables. We additionally control for sociodemographic characteristics, personality traits, economic preferences measures, and health-related behavior. To get a more causal estimate of the relationship between health status and PQI use, we implement a survey experiment. Lastly, we investigate self-perceived reliability of different PQI sources as a potential moderator.

Results: Especially variables which cause a need for new information, such as a changing health status or dissatisfaction with the previous physician affect PQI use. This is supported by the estimates from the survey experiment. The availability of enough physician choice options is significantly related to PQI use in general. The use of physician-rating websites is particularly related to digital literacy, social networks, and subjective reliability. A very similar pattern can be found for the potential use of a hypothetical statutory PQI source, with subjective reliability of the source playing an important role.

Implication for research and/or (healthcare) practice: Our findings help in understanding underlying processes of PQI use and can assist the introduction of a targeted high-quality feedback system for objective PQI in the outpatient sector. Targeting older patients might be especially effective if such a source succeeds in communicating the objective high-quality of the information to increase subjective reliability. Additionally, targeting patients with changing needs concerning the health system as well as providing information in a way that they also reach patients with low digital literacy and small social networks might be helpful.