Why do patients bypass the nearest hospital? An empirical analysis for orthopaedics care and neurosurgery in the Netherlands

Marco Varkevisser and Stéphanie van der Geest

Health, Econometrics and Data Group (HEDG) Working Papers from HEDG, c/o Department of Economics, University of York

Abstract: Using individual patient level hospital utilisation data for 2003, we examine the decisions of Dutch patients to bypass the nearest hospital for orthopaedics and neurosurgery. During our sample period, health insurers did not steer patients to preferred hospitals and performance indicators were only scarcely available. Nevertheless, both for orthopaedics care (38%) and neurosurgery (54%) numerous patients did not visit the nearest hospital. From the estimation results of our logit model it follows that extra travel time negatively influences the probability of hospital bypassing. Good waiting time performance by the nearest hospital also significantly decreases the likelihood of a bypass decision. Patients seem to place a lower negative value on extra travel time for orthopaedics care than for neurosurgery. The valuation of shorter waiting time also varies between these two types of hospital care. A good performance of the nearest hospital on waiting time decreases the likelihood of a bypass decision most for neurosurgery. In both samples patients were more likely to bypass the nearest hospital when it was a university medical centre or a tertiary teaching hospital. Patient attributes, such as age and social status, were also found to significantly affect hospital bypassing.

Keywords: health care; hospital bypassing; consumer choice; logit model (search for similar items in EconPapers)
JEL-codes: C25 D12 I11 (search for similar items in EconPapers)
Date: 2006-02
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