Do informed consumers in Taiwan favour larger hospitals? A 10-year population-based study on differences in the selection of healthcare providers among medical professionals, their relatives and the general population

Abstract

Objectives: Exploring whether medical professionals, who are considered to be 'informed consumers' in the healthcare system, favour large providers for elective treatments. In this study, we compare the inclination of medical professionals and their relatives undergoing treatment for childbirth and cataract surgery at medical centres, against those of the general population.

Design: Retrospective study using a population-based matched cohort data.

Participants: Patients who underwent childbirth or cataract surgery between 1 January 2004 and 31 December 2013.

Primary and secondary outcomes measures: We used multiple logistic regression to compare the ORs of medical professionals and their relatives undergoing treatment at medical centres, against those of the general population. We also compared the rate of 14-day re-admission (childbirth) and 14-day reoperation (cataract surgery) after discharge between these groups.

Results: Multivariate analysis showed that physicians were more likely than patients with no familial connection to the medical profession to undergo childbirth at medical centres (OR 5.26, 95% CI 3.96 to 6.97, p<0.001), followed by physicians' relatives (OR 2.68, 95% CI 2.20 to 3.25, p<0.001). Similarly, physicians (OR 1.63, 95% CI 1.21 to 2.19, p<0.01) and their relatives (OR 1.43, 95% CI 1.13 to 1.81, p<0.01) were also more likely to undergo cataract surgery at medical centres. Physicians also tended to select healthcare providers who were at the same level or above the institution at which they worked. We observed no significant difference in 14-day re-admission rates after childbirth and no significant difference in 14-day reoperation rates after cataract surgery across patient groups.

Conclusions: Medical professionals and their relatives are more likely than the general population to opt for service at medical centres. Understanding the reasons that medical professionals and general populations both have a preferential bias for larger medical institutions could help improve the efficiency of healthcare delivery.

Keywords: efficiency; elective treatment; gatekeeping; informed consumers; patient choice; universal healthcare.

Figure 1

OR of receiving care at a medical centre: medical professional, their relatives and the general population.

Figure 2

Comparison of the size of the healthcare provider where treatment was received by medical professionals with the size of the healthcare provider where medical professionals worked.