Why do patients bypass the nearest hospital? An empirical analysis for orthopaedics care and neurosurgery in the Netherlands

Using individual patient level hospital utilisation data for 2003, we examine the decisions of Dutch patients to bypass the nearest hospital for orthopaedics and neurosurgery. During our sample period, health insurers did not steer patients to preferred hospitals and performance indicators were only scarcely available. Nevertheless, both for orthopaedics care (38%) and neurosurgery (54%) numerous patients did not visit the nearest hospital. From the estimation results of our logit model it follows that extra travel time negatively influences the probability of hospital bypassing. Good waiting time performance by the nearest hospital also significantly decreases the likelihood of a bypass decision. Patients seem to place a lower negative value on extra travel time for orthopaedics care than for neurosurgery. The valuation of shorter waiting time also varies between these two types of hospital care. A good performance of the nearest hospital on waiting time decreases the likelihood of a bypass decision most for neurosurgery. In both samples patients were more likely to bypass the nearest hospital when it was a university medical centre or a tertiary teaching hospital. Patient attributes, such as age and social status, were also found to significantly affect hospital bypassing.