Patient Responses to Freedom of Choice - Evidence from the Finnish Health Care Reform in 2011

No Thumbnail Available
Journal Title
Journal ISSN
Volume Title
School of Business | Master's thesis
Ask about the availability of the thesis by sending email to the Aalto University Learning Centre oppimiskeskus@aalto.fi
Date
2017
Major/Subject
Mcode
Degree programme
Economics
Language
en
Pages
85
Series
Abstract
Many countries have introduced the patients’ right to choose the hospital in order to foster hospital quality competition and thus achieve higher care quality, among other things. A crucial precondition for the quality competition is that patients select higher quality hospitals when they are given the freedom to choose. The Finnish government legislated for the patient choice in 2011. Understanding whether the patients react to differences in provider quality in Finland is crucial for assessing the already-implemented policies, as well as for designing and implementing future policies successfully. According to previous studies from other countries patients are likely to use the opportunity to choose the hospital. Factors that typically affect the choice include distance to the hospital and waiting time – but also clinical quality has been found to impact patient choices in the literature. The aim of the thesis is to study how the patients reacted to the reform in Finland in 2011. To that end, firstly, I study the development of geographical patient mobility between 2007 and 2013 with linear regressions. Secondly, I interview experts and review other sources to learn whether the patients were likely to use the choice during the study period. Based on the empirical analysis, expert interviews, and literature review I highlight relevant issues for public policy. I use the Finnish Hospital Discharge Register to study the development of three patient mobility measures. I find that the patient mobility increased moderately after the reform: the share of patients crossing hospital district borders on their way to hospital increased from approximately 0.02 in 2010 to 0.025 in 2011–2013. The average distance travelled by the patients and the share of patients who bypass the closest feasible hospital increased only very little after the reform. The result of the empirical analysis is that the patient mobility increased moderately after the 2011 reform compared to pre-reform years, but the effect is economically small and statistically not significant. Furthermore, the effect is not necessarily the causal impact of the reform. I cannot rule out the possibility of other simultaneous events influencing patient mobility. According to the expert interviews, the patients were not typically choosing the hospital in the study period. In most cases they were not aware of their right to choose the hospital, and usually no information was available on the alternative hospitals or their qualities. In addition, the physicians did not actively offer the choice or support the patients in the choice making. In order to foster hospital quality competition it is important to ensure the patients know of their right to choose the hospital, and that they have information on which to base their decisions. Administering treatment prices is important to make sure hospitals compete on quality and not on price.
Description
Thesis advisor
Bagues, Manuel
Keywords
economics, taloustiede, healthcare economics, terveystaloustiede, patient choice, valinnanvapaus
Other note
Citation