Does quality affect patients’ choice of doctor? Evidence from the UK

Provider competition is a currently popular healthcare reform model. A necessary condition for greater competition to improve quality is that providers will face higher demand if they improve their quality. In this paper we test this crucial assumption in an important part of the health care market by examining whether quality affects the choice of family doctor. We use data on the choices made by 3.4 million English patients from amongst nearly 1000 family doctor practices to estimate the determinants of choice and, in particular, whether quality affects choice. The English setting is a particularly useful test bed since all individuals are entitled to register with a family physician and generally cannot access non-emergency hospital care without doing so. All care is free, so choice of family doctor is not affected by price. Moreover, measures of clinicalquality are publicly available. We find that patients do respond to quality and are willing to travel further to higher quality practices. Our estimates suggest that a one standard deviation increase in the publicly available measure of quality would increase the number of patients a practice would attract by around 15% of the practice patient list.