J Korean Med Assoc.  2012 Sep;55(9):898-910. 10.5124/jkma.2012.55.9.898.

Factors influencing medical institution selection for outpatient services

Affiliations
  • 1Institute of Health Insurance Research, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
  • 2Department of Humanities and Social Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. snukyd1@naver.com

Abstract

This study analyzes determinants of patients' choice of healthcare providers in outpatient services and identifies their effects. Data were collected from two waves of the Korean Health Panel. The unit of analysis was an outpatient visit (n=189,739). Various types of medical institutions were grouped into general hospitals (including tertiary hospitals), hospitals, and clinics. A multinomial logit model was used to examine the determinants of medical institution selection. Clinics were the most frequent (82.2%) medical institution selected, followed by general hospitals (10.9%) and hospitals (6.9%). Males and beneficiaries of Medical Aid were more likely to choose the upper-level institutions. The upper-level institution selection was also positively associated with the level of education, household income, and severe diseases, while negatively associated with the level of health status. The medical institution selection was significantly different by region. Not only enabling factors for healthcare utilization, such as family and community resources, but also the users' characteristics were strong determinants of the type of medical institution selected. We, therefore, recommend that patients' characteristics and needs, in addition to the sharing of roles and functions among medical institutions, should be considered in making healthcare policies for efficient medical utilization and an effective medical delivery system.

Keyword

Choice of healthcare provider; Consumer satisfaction; Outpatients; Delivery of health care

MeSH Terms

Consumer Satisfaction
Delivery of Health Care
Family Characteristics
Health Personnel
Health Status
Hospitals, General
Humans
Logistic Models
Male
Outpatients

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Reference

1. Park HG, Park YS. The change of hospitals bed supply and hospital utilizations of patients after the mid-1990s. Korean J Health Econ Policy. 2011. 17:145–172.
2. Kim YK, Kim JS. A study on healthcare institution selection of healthcare consumers using theory of consumption values: focusing on relations among clinics or small sized hospitals, general hospitals, and large-sized hospitals. J Korean Soc Quality Manage. 2009. 37:71–86.
3. Oh YH, Do SR, Son CK, Park DS, Kim JW, Yoon KJ, Moon JW, Lee KJ, Hong MY. Development and management of monitoring system to improve the efficiency of health care resources allocation: health care resources, Korea, 2010. 2010. Seoul: Korea Institute for Health and Social Affairs.
4. National Health Insurance Corporation. Health Insurance Review and Assessment Service. 2010 National health insurance statistical yearbook [Internet]. cited 2012 Aug 13. Seoul: National Health Insurance Corporation; Health Insurance Review and Assessment Service;Available from: http://www.nhic.or.kr/portal/site/main/menuitem.74b68c0b767ded38b31148b4062310a0/.
5. Ha CL. Four major hospitals: black hole for patients [Internet]. 2009. 06. 22. cited 2012 Aug 13. Seoul: Yonhap News Agency;Available from: http://app.yonhapnews.co.kr/YNA/Basic/article/new_search/YIBW_showSearchTotalList_New.aspx?searchpart=total&searchtext=%uD658%uC790%20%uBE14%uB799%uD640%204%uB300.
6. Ministry of Health and Welfare. Basic plan for re-setting role and function of medical providers [Internet]. 2011. cited 2012 Aug 13. Seoul: Ministry of Health and Welfare;Available from: http://www.mw.go.kr/front/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&BOARD_ID=140&BOARD_FLAG=00&CONT_SEQ=249986&page=1.
7. Choi YS, Baek SJ, Lim ES, Lee HY, Chang HJ. 2009 Survey of medical expenditure of National Health Insurance beneficiaries. 2010. Seoul: National Health Insurance Corporation.
8. Im GJ. Reorganization of the medical delivery system: a cause for the patients. J Korean Med Assoc. 2010. 53:442–444.
Article
9. Kim KH, Lee JC, Kim HN. A study on the re-establishment of functions of health care institutions. Public Policy Rev. 2011. 25:161–177.
Article
10. Jung SH, Kim HJ. Impacts of implementation of patient referral system in terms of medical expenditures and medical utilization. Korean J Prev Med. 1995. 28:207–224.
11. Kim SH. Increase of pharmacy expenses paid by patients in general hospitals [Internet]. 2011. 08. 02. cited 2012 Aug 13. Seoul: Yonhap News Agency;Available from: http://app.yonhapnews.co.kr/YNA/Basic/article/new_search/YIBW_showSearchArticle_New.aspx?searchpart=article&searchtext=%ec%95%bd%ec%a0%9c%eb%b9%84+%eb%b3%b8%ec%9d%b8+%eb%b6%80%eb%8b%b4&contents_id=AKR20110802063800017.
12. The Korean Society for Preventive Medicine. Preventive medicine and public health. 2010. Seoul: Gyechukmunwhasa.
13. Cho WH, Kim HJ, Lee SH. A study on the criteria for selection of medical care facilities. Korean J Prev Med. 1992. 25:53–63.
14. Yu SY, Kim EH. A study on factors in selecting of hospital: focus on medical advertising implication. Korean J Advert. 2006. 17:201–214.
15. Youn KI, Doh SR. An analysis of the diseases specific medical service organization selection factors of patients. Korean J Hosp Manage. 2007. 12:1–21.
16. Jung EK. Choosing patterns for dental clinic among community people. J Dent Hyg Sci. 2010. 10:323–327.
17. Shin YH, Suh CJ. A study on WOM and determinants of hos-pital choice. Korean J Hosp Manage. 2011. 16:31–52.
18. Lim DG, Jaegal D. A study on factors in selecting hospital of the elderly in Andong. Soc Sci Res Rev. 2011. 27:121–139.
19. Jung SH, Jung HY, Kim EH. A study on the factors related to the choice of dental clinics for worker in Seoul. J Dent Hyg Sci. 2011. 11:427–439.
20. Choi MI, Kim CA, Yoo JW. An AHP study on priority factors affecting healthcare consumers' selection of hospitals: focused on marketing strategies of hospital services. Advert Res. 2011. 89:155–176.
21. Han WH, Park JH, Son SB, Hong HP, Jung SC, Kim MR, Kim YJ, Lee HS, Cho WS. Clinical analysis of characteristics of patients who visit otorhinolaryngology clinic in secondary general hospital. Korean J Otorhinolaryngol-Head Neck Surg. 2011. 54:203–207.
Article
22. Lee JC, Kim KH, Kim HN, Park YH. Factors associated with the hypertension outpatients' choice of healthcare providers in Korea. J Korean Med Assoc. 2011. 54:961–970.
Article
23. Park SB, Jung KH. The determinants of private health insurance and its effects on medical utilization in Korea. Korean Insur J. 2011. 88:23–49.
24. You CH, Kang SW, Kwon YD, Oh EH. The effects of supple-mentary private health insurance on healthcare utilization and expenditures: indemnity vs. fixed-benefit. Korean Soc Secur Stud. 2011. 27:277–292.
25. Bolduc D, Lacroix G, Muller C. The choice of medical providers in rural Benin: a comparison of discrete choice models. J Health Econ. 1996. 15:477–498.
Article
26. Habtom GK, Ruys P. The choice of a health care provider in Eritrea. Health Policy. 2007. 80:202–217.
Article
27. Adams EK, Houchens R, Wright GE, Robbins J. Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness. Health Serv Res. 1991. 26:583–612.
28. Lane PM, Lindquist JD. Hospital choice: a summary of the key empirical and hypothetical findings of the 1980s. J Health Care Mark. 1988. 8:5–20.
29. Maddala GS. Limited-dependent and qualitative variables in econometrics. 1983. Cambridge: Cambridge University Press.
30. Lee SH. A study of hospital choice on the basis of consumption values theory. J Prev Med Public Health. 1997. 30:413–427.
31. National Health Insurance Corporation. Health Insurance Review and Assessment Service. 2009 National health insurance statistical yearbook [Internet]. cited 2012 Aug 13. Seoul: National Health Insurance Corporation; Health Insurance Review and Assessment Service;Available from: http://www.nhic.or.kr/portal/site/main/menuitem.9046c7b1fca1aa404bf15151062310a0/.
32. Jeon GS, Choi ES, Lee HY. Gender-related difference in the utilization of health care services by Korean adults. J Korean Acad Public Health Nurs. 2010. 24:182–196.
33. Shin YS, Choi BH, Shin HY, Hwang DK, Yun SJ. A policy report for the current situation of medical aid expenditure and improvement direction. 2005. Seoul: Ministry of Health and Welfare; Korea Institute for Health and Social Affairs.
34. Kim ES, Kim MY, Ko IS, Lee DM, Kim KS, Choi JS. The current situation of medical aid utilization and improvement direction in long-term utilizers. 2007. Seoul: Ministry of Health, Welfare and Family Affairs.
35. Shin SM, Kim ES, Lee HW. The contributing factors to surplus medicine by long-term users of medical aid in Korea. J Prev Med Public Health. 2009. 42:403–407.
Article
36. Lee DH, Park EC, Nam CM, Lee SG, Lee DH, Yu SH. Comparing difference of volume of psychiatric treatments between the patient with health insurance and those with medical assistance: for inpatients of Korean psychiatric hospitals. Korean J Prev Med. 2003. 36:33–38.
37. Chang H, Kwon YD, Yoon SS. Impact of health insurance type on health care utilization in patients with acute cerebral infarction. J Korean Neurol Assoc. 2011. 29:9–15.
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