Does physician communication of hospital quality information influence patients' hospital choice? An experimental...

Provision of hospital quality information influences patients' hospital choice by reducing information asymmetry. In addition to public reporting, physician communication within clinical encounters offers a complementary channel, given its feasibility and demonstrated effectiveness in influencing patient decision-making and behaviour change. However, the impact of direct physician communication of hospital quality information on patients' hospital choice remains underexplored. Drawing upon the South Korean healthcare system-where inter-regional hospital bypassing (i.e. outmigration to hospitals in Seoul, the capital city) is prevalent-this study examines whether physician-delivered favourable hospital quality information affects patients' hospital choice.

An experimental vignette design was implemented with a nationwide sample of 1679 adults aged 19-69 years, excluding residents of Seoul. Following a hypothetical cancer diagnosis in a local tertiary hospital, respondents were randomised to one of three groups: control (no additional information), intervention-providing structural quality information (SQI) or intervention-providing outcome quality information (OQI) groups. Post-intervention measures included confidence in receiving surgery at the local hospital, perceived surgical outcomes, and outmigration intention for surgery. Intervention effects were analysed using one-way ANOVA, complemented by multiple linear regression models. Mediation analysis assessed whether confidence in receiving surgery and perceived surgical outcomes mediated the relationship between physician communication and outmigration intention.

Physician communication of favourable hospital quality information significantly reduced patients' intention to outmigrate for surgery. In the control group, 71.7% of respondents intended to outmigrate, compared with 59.2% and 55.3% in the SQI and OQI groups, respectively. Adjusting for baseline imbalances revealed reductions of 14.8 and 19.4 percentage points in the probability of reporting outmigration intention, respectively. Mediation analysis revealed substantial indirect effects for both SQI and OQI, with confidence-mediated pathways showing slightly stronger effects (SQI: B = -0.40; OQI: B = -0.36) compared to perceived outcome pathways (SQI: B = -0.29; OQI: B = -0.31). The direct effects of both interventions on outmigration intention became non-significant, suggesting full mediation.

Physician communication of hospital quality information during outpatient encounters significantly influences patients' hospital choice. Ensuring that discussions of hospital quality are systematically integrated into relevant clinical encounters is an important strategy for supporting patients in making informed hospital choices.