COULD PROVIDING MORE CHOICE FOR PUBLIC PATIENTS DRIVE HOSPITAL QUALITY IMPROVEMENTS IN AUSTRALIA?
Henry Cutler, Macquarie University
Tuesday August 8 12:00pm
Publically funded elective surgery patients in Australia have little informed choice when seeking hospital care. They have limited information on hospital quality and are generally directed towards their local public hospital, where they are treated by doctors nominated by the hospital. International research suggests patients want more choice over their health care. People feel empowered with choice, and when provided with choice, they exercise their right to choose. Yet demographic and socioeconomic status impacts willingness to choose. Some people find it difficult to interpret and use performance information. Others like the convenience of their local hospital, willing to trade off better quality for reduced travel distance.
Australia is currently experiencing a shift in government policy towards more choice in human services. The Australian Government completed a review of Competition Policy in Australia in 2015, which identified human services as an area for immediate competition reform. The Productivity Commission is currently reviewing the potential to increase competition within public hospitals, with findings due to be reported to the Australian Government towards the end of 2017.
While greater choice can improve hospital quality and health outcomes, this will only occur if patients value quality and exercise their right to choose. Given nearly half of all Australians have health insurance covering private hospital services, and that distances between public hospitals undertaking elective surgery outside capital cities can be vast, Australians may choose ‘not to choose’ if given greater choice across public hospitals, thereby limiting the benefits of any pro-choice policy.
This presentation assessed whether Australians want more choice over their public hospital care for elective surgery, and to what extent they value hospital quality relative to greater convenience. A choice modelling experiment was employed, surveying 1,000 Australians aged 50 to 75 years and asking them to choose between two hypothetical hospital choices, with respondents split into two elective care urgency categories before making their choices to test the impact of urgency on choice.
Results suggest that respondents value hospital quality the most, demonstrated through greater preference for reduced probability of adverse events and readmission rates relative to other attributes, including potential health gain, waiting times, distance from home to the hospital, GP opinion on hospital quality, and other patient experiences. Respondents were willing to trade off an improved health gain for a reduced probability of an adverse event. The opinion of other patient experiences was valued similarly to a GPs opinion. Respondents were willing to trade-off convenience for quality, through waiting longer for elective care and travelling longer distances to receive better quality hospital care. However, preferences were heterogeneous, with respondent characteristics such as gender, experience with hospitals, education, private health insurance status and remoteness of home, impacting the value of attributes.
Australians want more choice in public hospitals, and are willing to exercise that choice based on differences in hospital quality. This suggests increased choice across Australian public hospitals could drive quality improvements and improve health outcomes, particularly if supported by increased health literacy among the Australian population and GP assistance when selecting alternative public hospitals.
Dr Henry Cutler is the inaugural director of the Centre for the Health Economy at Macquarie University. In this role, Henry’s primary interest is investigating the Health Economy at the macro level, with particular focus on the interdependencies of the health, ageing and human services sectors with each other, and the broader economy. His aim is to inform public debate and assist decision-making through policy relevant research.
Henry has led or co-authored over 70 health economics publications on a broad range of topics for federal and state government departments, government agencies, and Australian and international non-government organisations. His focus is on policy analysis, economic evaluation, and using quantitative techniques to evaluate health care data. His current research focus is on health care funding models, performance measurement and choice and competition.
Henry holds a PhD in health economics, where his research focused on increasing efficiency within the health care system by allocating government spending to health care system attributes most valued by society.
Prior to Macquarie University, Henry was the national lead of KPMG’s health economics group, and led Access Economics’ health and social policy team in Sydney. He was also a senior economist at the Centre for International Economics, and spent eight years working in financial markets in Sydney and London.