In view of health care reform's consumer-based choice, this research pursues an enhanced understanding of health care choice behavior, specifically hospital outshopping, the bypassing of local hospitals. Multivariate analysis of variance, cross-tabulation, and log-linear analyses of responses to a mail survey of rural residents of southern Illinois reveal the following: (1) Consumers’ quality perceptions play a central role in explaining hospital choice behavior, (2) Perceptions of low local hospital quality are held by both users and nonusers of local hospitals, and (3) Consumers’ behavioral intentions do not comport with past behavior. Health care policy should incorporate these findings.
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