It's your Choice! A Study of Search and Selection Processes, and the Use of Performance Indicators in Different Patient Groups

In the last few years, the Dutch health care system has undergone the most radical changes since the Second World War. Most people are now aware that competition has become one of the leading principles of the new health care system. A tangible expression of this change came when, on 1 January 2006, all Dutch citizens had to choose a health care insurer. Under the new system, citizens are given more freedom of choice, more choice options and thus more responsibilities for their own choices In health care - not just in their role as insured parties, but also as patients. Most policymakers and scholars are convinced that people are not able to make deliberate choices on the health care market unless they are provided with accessible and understandable information about the price and quallty of a particular treatment. However, defining the quallty of a health care product has proved to be much more difficult than translating its costs into a price (something with which citizens are not really confronted because of their insurance). As a consequence, great efforts have been in the realms of policy and research to defining relevant aspects of quality, its measurement and the public disclosure of its results. Performance or quality indicators are instruments that are increasingly being used as a means of inducing transparency in health care quality. This doctoral thesis investigates and answers the question as to the extent to which performance indicators (can) playa role in the search and selection processes of patients who are looking for a health care provider. Chapter 1 provides an introduction to this research question. It describes recent developments that have changed Dutch health care from a supply-driven to a more demand-driven system, based on the principles of regulated competition. In addition, it reveals the Achilles heel of the health care market - the asymmetrical relationship between patients and their doctors - and stresses the importance of consumer information for patients. This leads to the above research question.

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