Determinants of citizens' choice between public and private hospitals.

Abstract

Objective: This study assesses what factors determine citizens' preferences for a public or private hospital (assuming the choice is free of charge) according to the severity of the disease.

Material and method: A web-based discrete choice experiment was carried out with 1777 individuals distinguishing between a control group (posed with a simple choice for each health condition) and added information for respondents of the treatment groups (distance, waiting time, advice from the family doctor, and recommendations from the social context). The relevance of these factors in relation to the severity of one's illness is investigated. The outcome variable is the choice of a public versus a private hospital for the treatment of a health issue of a different severity.

Results: The severity of the health issue has a moderator effect on the additional information for the treatment groups. Waiting time has a direct positive impact on the patient's preferred choice for a private hospital both for severe and non-severe health issues. Distance to the hospital and the family doctor's recommendation positively impact the preferred choice for a private hospital for non-severe health issues but not for severe health issues. Covariates like gender and age are not relevant in explaining the effects of the treatments, and educational level has a positive impact on one of the treatments: advice from the patient's environment. Satisfaction with public hospitals has a positive impact on all treatments.

Conclusions: Results indicate that waiting time is a key factor in choosing a private hospital against the majority-stated preference for a public hospital.