Does location matter? A study of the public's preferences for surgical care provision

As in other countries, office-based surgeons, outpatient clinics and hospitals in Germany are in increasing competition to each other. However, little is known about potential patients' preferences for surgical care provision. The aim of this study was to investigate the general public's preferences towards location and other attributes of surgical treatment.

An economic evaluation technique, discrete choice analysis, was administered in a survey to a sample of a German general public Internet panel, representative in terms of age, gender and education. Responders were asked to choose their preferred provider of surgical care in a series of pairwise choices, defined by five attributes. Regression analysis was used to quantify preferences towards characteristics of care and to calculate utilities of treatment scenarios. The strength of preferences and the rate at which participants were willing to trade among attributes were estimated.

The response rate was 76% (n=1134). 'Specialization and experience of provider' was the single most important attribute, followed by 'waiting times' and 'staff continuity'. Subjects traded a 4-week waiting time to obtain surgery at a highly specialized institution. Responders favoured outpatient clinics over office-based and inpatient surgery, but 'location of care' preferences were only weak. Whether participants had undergone surgery in the past had only minor effect on their preferences.

Potential patients base their choice between providers mainly on characteristics of care delivery and not location of care. The competition between and among providers of surgical care of different types of institutional organization will be determined by what is offered to patients.