Patient choice and consent

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

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Dynamic Appointment Scheduling for Outpatient Clinics with Multiple Physicians and Patient Choice

Journal of Management Science and Engineering ◽

10.1016/j.jmse.2021.02.002 ◽

2021 ◽

Author(s):

Chongjun Yan ◽

George G.Q. Huang ◽

Yong-Hong Kuo ◽

Jiafu Tang

Keyword(s):

Appointment Scheduling ◽

Patient Choice ◽

Outpatient Clinics

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Advance care planning for patients with COVID-19: a communication guide

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0571 ◽

2021 ◽

pp. 1-6

Author(s):

Natasha Palipane ◽

Abi Ponnampalampillai ◽

Srirupa Gupta

Keyword(s):

Advance Care Planning ◽

Symptom Control ◽

Patient Choice ◽

High Morbidity ◽

Care Planning ◽

Goals Of Care ◽

Disease Trajectory ◽

Improve Symptom ◽

Inappropriate Admissions ◽

Advance Care

In view of the high morbidity and mortality associated with COVID-19, early and honest conversations with patients about goals of care are vital. Advance care planning in its traditional manner may be difficult to achieve given the unpredictability of the disease trajectory. Despite this, it is crucial that patients' care wishes are explored as this will help prevent inappropriate admissions to hospital and to critical care, improve symptom control and advocate for patient choice. This article provides practical tips on how to translate decisions around treatment escalation plans into conversations, both face-to-face and over the phone, in a sensitive and compassionate manner. Care planning conversations for patients with COVID-19 should be individualised and actively involve the patient. Focusing on goals of care rather than ceilings of treatment can help to alleviate anxiety around these conversations and will remind patients that their care will never cease. Using a framework such as the ‘SPIKES’ mnemonic can help to structure this conversation. Verbally conveying empathy will be key, particularly when wearing personal protective equipment or speaking to relatives over the phone. It is also important to make time to recognise your own emotions during and/or after these conversations.

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As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

BMC Health Services Research ◽

10.1186/s12913-021-06392-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jonas Wohlin ◽

Clara Fischer ◽

Karin Solberg Carlsson ◽

Sara Korlén ◽

Pamela Mazzocato ◽

...

Keyword(s):

Cost Control ◽

Care Quality ◽

Patient Choice ◽

Public Healthcare ◽

Successful Implementation ◽

Publicly Funded ◽

Public And Private ◽

Bundled Payment ◽

Private Providers ◽

Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

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A clinical update on managed care implications for Australian psychiatric practice

Australasian Psychiatry ◽

10.1177/10398562211030011 ◽

2021 ◽

pp. 103985622110300

Author(s):

Jeffrey CL Looi ◽

Stephen R Kisely ◽

Tarun Bastiampillai ◽

William Pring ◽

Stephen Allison

Keyword(s):

Health Insurance ◽

Managed Care ◽

Private Health Insurance ◽

Psychiatric Treatment ◽

Patient Choice ◽

Insurance Sector ◽

Cost Cutting ◽

Appropriate Treatment ◽

The Us ◽

Limit Access

Objective: To provide a clinical update on private health insurance in Australia and outline developments in US-style managed care that are likely to affect psychiatric and other specialist healthcare. We explain aspects of the US health system, which has resulted in a powerful and profitable private health insurance sector, and one of the most expensive and inefficient health systems in the world, with limited patient choice in psychiatric treatment. Conclusions: Australian psychiatrists should be aware of changes to private health insurance that emphasise aspects of managed care such as selective contracting, cost-cutting or capitation of services. These approaches may limit access to private hospital care and diminish the autonomy of patients and practitioners in choosing the most appropriate treatment. Australian patients, carers and practitioners need to be informed about the potential impact of private managed care on patient-centred evidence-based treatment.

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846-2 Should volume influence patient choice of hospital for aortic valve replacement?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)91767-6 ◽

2004 ◽

Vol 43 (5) ◽

pp. A419

Author(s):

Karl F Welke ◽

Mary S Vaughn Sarrazin ◽

Gary E Rosenthal

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Patient Choice

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The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2018.7423 ◽

2018 ◽

Vol 48 (2) ◽

pp. 63-71 ◽

Cited By ~ 13

Author(s):

Thomas R. Denninger ◽

Chad E. Cook ◽

Cole G. Chapman ◽

Timothy McHenry ◽

Charles A. Thigpen

Keyword(s):

Physical Therapy ◽

Patient Choice ◽

Patient Registry ◽

Outcomes Analysis

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Do patients value a hospital’s innovativeness reputation? A multi-method approach to assess the relative importance of innovativeness reputation in patients’ hospital choice

Health Services Management Research ◽

10.1177/0951484817748157 ◽

2017 ◽

Vol 31 (3) ◽

pp. 138-153 ◽

Cited By ~ 1

Author(s):

Sebastian Gurtner ◽

Nadine Hietschold ◽

María Vaquero Martín

Keyword(s):

Value Added ◽

Patient Choice ◽

Relative Importance ◽

Hospital Choice ◽

Patient Decision ◽

Technical Innovations ◽

Multi Method Approach ◽

Method Approach

Innovations in health care are costly and risky, but they also provide the opportunity for hospitals to increase quality of care, to distinguish themselves from competitors and to attract patients. While numerous hospitals strive to increase their innovativeness by adopting a costly innovation leader strategy, the question of whether this actually influences the patient’s choice remains unanswered. To understand the role of innovativeness from the patient perspective, this study conceptualizes the construct of innovativeness reputation of hospitals and determines its relevance in patients’ hospital choice decisions. In the pretest, we identified six dimensions of innovativeness reputation such as progressive work procedures and value added services. We then used three different quantitative multi-criteria decision-making methods to evaluate the relative importance of innovativeness reputation in patient choice. We collected data from 355 former German patients who had undergone elective non-emergency surgery. Overall, innovativeness reputation accounts for 11.6%–16.8% of the patient decision. Innovativeness reputation has a moderate influence on hospital choice and should be taken into account by managers. Since technical innovations are costly, hospitals should use other means to enhance their innovative image. Strategies such as emphasizing value added services can enable hospitals to increase their innovativeness reputation efficiently.

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