Barts or Basildon?
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Barts or Basildon? Are patients willing to travel for healthcare? RAND Europe’s report on patient choice RESEARCH APPROACH RAND Europe was approached by the Department of Health to evaluate the impact of nationwide choice at the point of referral. This study followed an earlier London choice pilot project in collaboration with King's Fund and City University. We used Stated Preference methodology to investigate how people would make decisions when faced with a choice of providers, and identified the factors that mattered most to different groups of patients. BACKGROUND choice' in provision of public services has Labour came to power. It is a particularly where patients have typically been offered hospital. The alternative was to pay for private We asked over 1,000 recently-referred patients how they might have acted if they had been offered a choice of provider. Each patient was presented with hypothetical scenarios in choosing hospital treatment based on selected attributes, which included travel time and costs (and whether costs would be refunded or not), data on hospital performance (including waiting times) and the advice (if any) of the GP. They were asked how they would have chosen if these had been the hospital choices available to them at the point of referral. The data was used to construct models to predict how patients would make choices when given real alternatives. With long waiting lists at many hospitals and unused capacity at others, the Government decided that patients should get a choice between NHS hospitals at the point of GP referral. But no empirical evidence existed to show: how patients would respond to being offered choice by their GP whether they would be willing to travel to receive faster treatment what trade-offs they might make between factors such as waiting time, travel time, travel costs and quality of care. WHICH WOULD YOU CHOOSE? Policy makers needed greater insight into the drivers of patient choice to accurately forecast demand, and provide appropriate systems and support. If you had been offered these choices when your GP referred you to the hospital, which provider would you have chosen, and how would you have travelled to the hospital? Local hospital Hospital 2 Hospital 3 Hospital 4 Hospital 5 Travel time by car Travel cost by car, including parking costs 20 mins £3.00 3 hrs 30 min £31.50 3 hrs 30 min £23.60 4 hrs £27.00 4 hrs £27.00 QUALITY OF CARE MATTERS Travel time by public transport Travel cost by public transport 25 mins £4.00 3 hrs 30 min £16.80 2 hrs 5 min £10.00 3 hrs 10 min £38.00 3 hrs 10 min £30.40 Of the different aspects of provider performance, clinical quality (measured in terms of impact on patients' health) exerted the largest influence on choice of hospital. Travel costs refunded by hospital All patients HTCS only HTCS only HTCS only HTCS only 20 weeks 22 weeks 8 weeks 24 weeks 14 weeks Provider Location Information provided by the NHS A. Convenience and efficiency B. Hospital facilities, standards and food C. Personal experience of care D. Impact on health (based on hospital performance) E. Waiting times (from referral to treatment) GP opinion of hospital Recommended GP SUPPORT IMPORTANT BUT NOT CRITICAL GP advice about which hospital to choose is important, but does not entirely override other information such as hospital performance and travel time. The value that people attribute to the GP's advice depends upon the direction of that advice – patients place more weight on negative advice than positive advice. This suggests that it would benefit hospital trusts to build close relationships with GPs. IMPACT Pioneering data. This RAND Europe research provides important empirical data on patient choice decision-making. It has become an essential reference source for the Department of Health in their policy implementation. Broadening policy debate. The findings have widened the focus from waiting times to a broader awareness of other important variables that influence choice, and the differences in preferences between patient groups. Evolving models. Further RAND Europe research can continuine to inform policy by analysing how choice-making behaviour develops as people become more familiar with the concept of patient choice. Providing an operational tool. The models developed by RAND Europe can assist hospital trusts in better understanding the demand for their services in a competitive patient market. Adapting methodology to new areas. Stated preference techniques have been used extensively in transport. Other policy areas involving an understanding of choice behaviour can also benefit from their application, such as health, education and social care. CERTAIN GROUPS ARE LESS WILLING TO TRAVEL The study found that some groups are much less likely to travel to an alternative hospital, even if it has a better reputation. Patients who are older, female, typically travel by bus, have dependent children or have lower education levels are all more likely to choose their local hospital. These differences raise questions about equal access for those in equal need, given the apparent social differences in patients' willingness to travel for better care. 10 WEEKS IS THE WAITING TIME 'TIPPING POINT' Patients were offered alternative hospitals with waiting times that could be either longer or shorter than at their local hospital. The research found that reducing waiting times below 10 weeks was not valued by respondents, and exerted no influence over choice of hospital. However, once waiting times reached 10 weeks, respondents were increasingly willing to choose an alternative hospital to get faster treatment. 0.0 -0.5 Value (utils) The concept of 'consumer been a policy theme since radical concept in the NHS, treatment only at their local care. 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 -1.0 -1.5 -2.0 -2.5 -3.0 -3.5 Waiting time (weeks) Waiting times over 10 weeks had a linear decrease in utility THE ARTS CHILD POLICY CIVIL JUSTICE This PDF document was made available from www.rand.org as a public service of the RAND Corporation. EDUCATION ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY This product is part of the RAND Corporation corporate publication series. Corporate publications describe or promote RAND divisions and programs, summarize research results, or announce upcoming events. 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