Choice in public services: A multilevel analysis of doctor choice in 25 countries

Proposal to the ECPR 2012 conference, Antwerp 10-15 April 2011, Workshop 5: Citizens and Public Service Performance: Demands, Responses and Changing Service Delivery Mechanisms CHOICE IN PUBLIC SERVICES: A MULTILEVEL ANALYSIS OF DOCTOR CHOICE IN 25 COUNTRIES Steven Van de Walle (Erasmus University Rotterdam, Department of Public Administration) & Sofie Marien (K.U.Leuven, Centre for Political Research) The introduction of choice in public services, and in health services more specifically, is part of a wider movement to introduce consumerism in health care, and to strengthen user involvement (Clarke et al. 2007, Dowding, John & Mergoupis 2000). This, it was thought, would allow tailoring services to users’ needs, improve quality through introducing market pressure, and generally align supply with demand (Le Grand 2007). Choice is receiving increasing attention. In the health sector, there have been quite a few studies focusing on hospital choice (Berendsen et al. 2010, Berendsen et al. 2009)(Lako, Rosenau 2009), yet choice of GPs has only received scant attention. In the latter, studies have mainly concentrated on factors determining choice; factors determining whether a patient will exercise choice (or exit); or the effect of choice on patient trust (Chu-Weininger, Balkrishnan 2006)on criteria patients use to choose a doctor (Butler, McGlone 2002)(Bornstein, Marcus & Cassidy 2000)(Biørn, Godager 2010)(Donaldson, Lloyd & Lupton 1991). In this paper, we will analyse how citizens evaluate the availability of choice in 25 European countries, and what drives these evaluations. We expect health system characteristics, one’s personal health situation, a range of personal characteristics such as socio-demographics and political left-right self-orientation and attitudes to choice to have an effect on how people evaluate choice. We use data from the European Social Survey (Round 2, 2004) (25 countries, N=47,537). Respondents were asked whether in choosing their regular GP they felt they had enough choice. Answers to this question vary widely across countries, ranging from 95.5 of respondents being satisfied with the choice offered in Belgium, to a mere 18.7 in the Ukraine. In this paper we use multi-level techniques to analyze both individual-level and country-level determinants of these evaluations. At the individual level, we will look at the impact of personal health, evaluation of the country’s health services, personal preference for choice in health, political left-right self-orientation, whether one lives in a rural or urban area, age and education At the country level, we will look at GP density in the country, health expenditure and the formal extent of choice Contact details Steven Van de Walle Professor of Public Administration vandewalle@fsw.eur.nl Department of Public Administration Erasmus University Rotterdam P.O. Box 1738, room M7-12 3000 DR Rotterdam The Netherlands Sofie Marien Postdoctoral Researcher Sofie.marien@soc.kuleuven.be Centre for Political Research Parkstraat 45 Box 3602 3000 Leuven Belgium References Berendsen, A.J., de Jong, G.M., Meyboom-de Jong, B., Dekker, J.H. & Schuling, J. 2009, "Transition of care: experiences and preferences of patients across the primary/secondary interface - a qualitative study", BMC health services research, vol. 9, pp. 62. Berendsen, A.J., de Jong, G.M., Schuling, J., Bosveld, H.E.P., de Waal, M.W.M., Mitchell, G.K., van der Meer, K. & Meyboom-de Jong, B. 2010, "Patient''s need for choice and information across the interface between primary and secondary care: A survey", Patient education and counseling, vol. 79, no. 1, pp. 100-105. Biørn, E. & Godager, G. 2010, "Does quality influence choice of general practitioner? An analysis of matched doctor-patient panel data", Economic Modelling, vol. 27, no. 4, pp. 842-853. 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