Patient choice of a healthcare provider at the point of referral.

Background: In the last decade many countries in Europe have implemented patient choice and managed competition. Policymakers assume that patients behave as active rational consumers and actively choose the provider that best fits their needs and preferences. With the introduction of managed competition, health insurers make up an important third party. On behalf of their customers, they purchase services and are allowed to contract selectively. Taking one’s insurance into account when choosing a provider became therefore increasingly important. There is, however, little evidence that patients make active choices in the way policymakers assumed. Instead, many patients visit the provider that is recommended by their general practitioner (GP). This research aims to investigate the role of patients in choosing a healthcare provider at the point of referral and what the roles of the GP and the health insurer are in this process. Methods: In 2015-2016, we videotaped Dutch GP-patient consultations. The videotaped consultations between 475 patients and 28 GPs in which the patient was referred to a healthcare provider were coded by three observers. We used an observation protocol to describe the referral process. Results: Patients were divided into three groups: patients with little or no input, with some input and with much input. More than half of the patients (56%) seemed to have some or much input into the choice of a healthcare provider at point of referral by their GP. In almost half of the consults (47%) GPs asked for the patients’ preferences. The health insurance of a patient was rarely discussed at the point of referral. Conclusions: More than half of the patients seem to have some or much input into the choice of a healthcare provider at point of referral by their GP. However, still half of the patients had little or no input. If patient choice remains important for policy, GPs should discuss more options with their patients and should also name the health insurer. Key messages: In 53% of the consultations the GP does not ask the patient about the preference of a provider. The health insurance of a patient is rarely discussed during GP-patient consultations.