The changing competitive hospital environment and recent greater availability of patient origin data have stimulated an increased research interest in factors influencing the reason patients are admitted to one hospital over another. Hospital marketers and managed care planners seek information for attracting patients and for negotiating hospital provider networks, respectively. Hospital choice models can help regulators make better informed assessments of the welfare implications of proposed mergers or closures. The literature shows the development of increasingly sophisticated models and techniques for analysis of hospital choice. Recent studies have also related the findings to health policy issues. This review summarizes the historical developments and the cumulative knowledge gained about hospital choice to date, identifies some key issues in need of greater attention, and assesses the potential strengths and limitations of contemporary choice models for making policy impact assessments.
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References
1.
Acton, J. P."Demand for Health Care among the Urban Poor: With Special Emphasis on the Role of Time." In The Role of Health Insurance in the Health Services Sector, edited by R. N. Rosett, 165-174. New York: National Bureau of Economic Research, 1976.
2.
Adams, E. K. , R. Houchens, G. E. Wright, and J. Robbins. "Predicting Hospital Choice for Rural Medicare Beneficiaries: The Role of Severity of Illness."Health Services Research26 (December 1991): 583-612.
3.
Adams, E. K. , and E. Porell. "Estimating the Utilization Impacts of Hospital Closures through Hospital Choice Models: A Comparison of Disaggregate and Aggregate Models." Final Report to the Health Care Financing Administration. Institute for Health Policy, Brandeis University, 1992.
4.
Adams, E. K. , G. Wright, and J. Robbins. "Evaluation of the Rural Secondary Specialty Center Demonstration Project." Final report to the Health Care Financing Administration. Systemetrics Inc., Lexington, MA, August 1989.
5.
Andersen, R.A Behavioral Model of Families' Use of Health Services. Chicago: Center for Health Administration Studies, University of Chicago, 1968.
6.
Atherton, T. H. , and M. E. Ben-Akiva. "Transferability and Updating of Dissaggregate Travel Demand Models."Transportation Research Record, no. 610 (1976): 12-18.
7.
Bashshur, R. L. , G. W. Shannon, and C. A. Metzner. "Some Ecological Differentials in the Use of Medical Services."Health Services Research6 (spring 1971): 61-75.
8.
Ben-Akiva, M. E. , and S. R. Lerman. Discrete Choice Analysis: Theory Application to Travel Demand. Cambridge, MA: MIT Press, 1985.
9.
Berkowitz, E. , and W. Flexner. "The Market for Health Services: Is There a Nontraditional Consumer?"Journal of Healthcare Marketing1 (anuary 1981): 25-34.
10.
Berkson, J."Why I Prefer Logits to Probits."Biometrika7, no. 4 (1951): 327-329.
11.
Bishop, C. E. , H. O. Pollakowski, and G. E. Weisbrod. "Living Alone with Others as an Alternative to Nursing Home Use."Journal of Applied Gerontology10 (November 1991): 274-292.
12.
Boscarino, J. , and S. Steiber. "Hospital Shopping and Consumer Choice."Journal of Healthcare Marketing2 (April 1982): 15-23.
13.
Bronstein, J. M. , and M. A. Morrisey. "Bypassing Rural Hospitals for Obstetrics Care."Medical Care16 (spring 1991): 87-118.
14.
Burns, L. , and D. Wholey. "The Impact of Physician Characteristics in Conditional Choice Models for Hospital Care."Journal of Health Economics11 (January 1992): 43-62.
15.
Coffey, R. M."The Effect of Time Price on Demand for Medical Care Services."Journal of Human Resources18 (summer 1983): 407-424.
16.
Cohen, M. A. , and H. L. Lee. "The Determinants of Spatial Distribution of Hospital Utilization in a Region."Medical Care23 (1 February 1985): 27-38.
17.
Dranove, D. , W. D. White, and L. Wu. "An Analysis of Admission Patterns in Local Hospital Markets." Paper presented at Boston University/Harvard Seminar Series, February 1988.
18.
Ellis, R."Employee Choice of Health Insurance."Review of Economics and Statistics71 (May 1989): 215-223.
19.
Elzinga, K. , and T. Hogarty. "The Problem of Geographic Market Delineation Revisited: The Case of Coal."The Antitrust Bulletin23 (1978): 1-18.
20.
Erickson, G. M. , and S. A. Finkler. "Determinants of Market Share for a Hospital's Services."Medical Care23 (August 1985): 1003-1018.
21.
Folland, S. T."Predicting Hospital Market Shares."Inquiry20 (spring 1983): 34-44.
22.
Garnick, D. W. , E. Lichtenberg, C. S. Phibbs, H. S. Luft, D. J. Peltzman, and S. J. McPhee. "The Sensitivity of Conditional Choice Models for Hospital Care to Estimation Technique."Journal of Health Economics8 (February 1989): 377-397.
23.
Garnick, D. W. , H. S. Luft, J. C. Robinson, and J. Tetreault. "Appropriate Measures of Hospital Market Areas."Health Services Research22 (1 April 1987): 69-90.
24.
Gertler, P. , R. Sturm, and B. Davidson. "Information and the Demand for Supplemental Health Insurance." Paper presented at the winter meetings of the Econometrica Society, Boston, 1994.
Hansen, S."Pro Cross-Cultural Transferability." In New Horizons in Behavioural Travel Research, edited by W. Brog, P. R. Stopher, and A. H. Meyburg, 125-147. Lexington, MA: Lexington Books, 1980.
27.
Hausman, J. A. , and D. A. Wise. "A Conditional Probit Model for Qualitative Choice: Discrete Decisions Recognizing Interdependence and Heterogeneous Preferences."Econometrica46 (March 1978): 403-426.
28.
Henser, A. D. , and L. W. Johnson. Applied Discrete Choice Modeling. New York: Wiley, 1981.
29.
Jackson, B. , and J. Jensen. "Majority of Consumers Support Advertising of Hospital Services."Modern Healthcare14 (April 1984): 93-97.
30.
Jarvis, E."On the Supposed Increase of Insanity."Journal of Insanity8 (1851-52): 333-364.
31.
Javagli, R. , S. Rao, and E. Thomas. "Choosing a Hospital: Analysis of Consumer Tradeoffs."Journal of Health Care Marketing11 (March 1991): 12-22.
32.
Kim, B."A Logit Analysis of Hospital Choice Behavior in Chollabukdo Province of Korea."Social Science and Medicine30 (October 1990): 1119-1129.
33.
Lane, M. P. , and J. D. Lindquist. "Hospital Choice: A Summary of the Key Empirical and Hypothetical Findings of the 1980s."Journal of Health Care Marketing8 (December 1988): 5-20.
34.
Luce, R. D.Individual Choice Behavior: A Theoretical Analysis. New York: Wiley, 1959.
35.
Luft, H. S. , D. W. Garnick, D. H. Mark, D. J. Peltzman, C. S. Phibbs, E. Lichtenberg, and S. J. McPhee. "Does Quality Influence Choice of Hospital?"Journal of the American Medical Association263 (June 1990): 2899-2906.
36.
Luft, H. S. , D. Garnick, C. Phibbs, D. Peltzman, and E. Lichtenberg. "Modeling the Effect of Hospital Charges and Quality on Choice."Journal of Health Care Marketing11 (September 1991): 2-11.
37.
Mayer, J."The Distance Behavior of Hospital Patients: A Disaggregated Analysis."Social Science and Medicine17 (December 1984): 819-827.
38.
McFadden, D."Conditional Logit Analysis of Qualitative Choice Behavior." In Frontiers in Econometrics, edited by P. Zarembka, 106-142. New York: Academic Press, 1974.
39.
McGuirk, M. A. , and F. W. Porell. "Spatial Patterns of Hospital Utilization: The Impact of Distance and Time."Inquiry21 (spring 1984): 84-95.
40.
Melnick, G. A. , J. Zwanziger, A. Baezai, and R. Pattison. "The Effects of Market Structure and Bargaining Position on Hospital Prices."Journal of Health Economics11 (October 1992): 217-223.
41.
Morrill, R. L. , and R. J. Earickson. "Hospital Variation and Patient Travel Distances."Inquiry5 (spring 1968a): 26-34.
42.
Morrill, R. L. , and R. J. Earickson"Variation in the Character and Use of Chicago Area Hospitals."Health Services Research3 (fall 1968b): 224-238.
43.
Morrill, R. L. , R. J. Earickson, and P. Rees. "Factors Influencing Distances Traveled to Hospitals."Economic Geography46 (April 1970): 161-171.
44.
Morrisey, M. A. , F. A. Sloan, and J. Valvona. "Defining Geographic Markets for Hospital Care."Law and Contemporary Problems51 (spring 1988): 165-194.
45.
Nakanishi, M. , and L. Cooper. "Parameter Estimator for a Multiplicative Competitive Interaction Model-Least Squares Approach."Journal of Marketing Research11 (August 1974): 303-311.
46.
Pauly, M. V. , and K. W. Langwell. "Research on Competition in the Market for Health Services: Problems and Prospects."Inquiry20 (summer 1983): 142-161.
47.
Phelps, C. E."A Welfare-Based Approach to Analyzing Markets and Mergers."Journal of Health Economics8 (February 1989): 363-376.
48.
Phibbs, C. , D. Mark, H. Luft, D. Peltzman-Rennie, D. Garnick, E. Lichtenberg, and S. McPhee. "Choice of Hospital for Delivery: A Comparison of High Risk and Low Risk Women."Health Services Research28 Uune 1993): 201-220.
49.
Porell, F."Hospital Services Areas and Market Competition." Working paper, Bigel Institute for Health Policy, Brandeis University, 1986.
50.
Roghmann, K. J. , and T. R. Zastowny. "Proximity as a Factor in the Selection of Health Care Providers: Emergency Room Visits Compared to Obstetric Admissions and Abortions."Social Science and Medicine13D (March 1979): 61-69.
51.
Roos, N. P."Predicting Hospital Utilization by the Elderly: The Importance of Patient, Physician, and Hospital Characteristics."Medical Care27 (October 1989): 905-919.
52.
Shannon, G. W. , R. L. Bashshur, and C. A. Metzner. "The Concept of Distance as a Factor in the Accessibility and Utilization of Health Care."Medical Care Review26 (February 1969): 143-161.
53.
Shannon, G. W. , J. L. Skinner, and R. L. Bashshur. "Time and Distance: The Journey for Medical Care."International Journal of Health Services3 (November 1973): 237-244.
54.
Soldo, B. , D. Wolf, and E. Agree. "Family Household, and Care Arrangements of Frail Older Women: A Structural Analysis."Journal of Gerontology45 (November 1990): S238-S247.
55.
Stewart, J. Q."Demographic Gravitation: Evidence and Application."Sociometry12 January 1948): 31-58.
Studnicki, J."The Minimization of Travel Effort as a Delineating Influence for Urban Hospital Service Areas."International Journal of Health Services5 (November 1975b): 679-693.
58.
Systemetrics/McGraw-Hill . "AHCPR Hospital Cost Data Base Feasibility Study-Final Report."Agency for Health Care Policy and Research, Rockville, MD, 1992.
59.
Theil, H."A Multinomial Extension of the Linear Logit Model."International Economic Review10 (October 1969): 251-259.
60.
Wennberg, J. E."Population Illness Rates Do Not Explain Population Hospitalization Rates."Medical Care25 (April 1987): 354-359.
61.
Wennberg, J. E. , and A. Gittelsohn. "Small Area Variations in Health Care Delivery."Science182 (December 1973): 1102-1108.
62.
Wennberg, J. E. , and A. Gittelsohn"Variations in Medical Care among Small Areas."Scientific American246 (April 1982): 120-134.
63.
Werden, G. J."The Limited Relevance of Patient Migration in Market Delineation for Hospital Merger Cases."Journal of Health Economics8 (February 1989): 363-376.
64.
Wolinsky, E. D. , and R. S. Kurz. "How the Public Chooses and Views Hospitals."Hospital and Health Services Administration29 (November/December 1984): 58-67.
65.
Zwanziger, J."Antitrust Considerations and Hospital Markets."Journal of Health Economics8 (February 1989): 457-464.
66.
Zwanziger, J. , and G. A. Melnick. "The Effects of Hospital Competition and the Medicare PPS Program on Hospital Behavior in California."Journal of Health Economics7 (1988): 301-320.
67.
Zwanziger, J. , G. A. Melnick, and J. M. Mann. "Measures of Hospital Market Structure: A Review of the Alternatives and a Proposed Approach."Socio-Economic Planning Sciences24, no. 2 (1990): 81-95.
