Unterschiede in der Krankenhauswahl zwischen stationär behandelten Patienten, Schwangeren in der Geburtshilfe und Eltern pädiatrischer Patienten, eine querschnittliche Erhebung

Introduction: Free choice of hospital is promoted in health policy in Germany. It is intended to increase patient participation and improve the quality of health care through increased competition between hospitals. Although numerous studies already provide findings on hospital choice, there are no studies yet available for the German health care system that examine the approach to the treatment situation, across interventions and diagnoses, comparatively by speciality and taking into account health status. The aim of this work is to gain insights into the hospital choice behaviour of all inpatients in Germany, taking into account health status and gender. For this purpose, differences and similarities between ill patients, healthy patients and parents of paediatric patients are investigated, comparatively according to speciality and taking into account the time before admission. In addition, two in-depth group comparisons are made on the influence of the factors gender and health status. Finally, potential factors influencing the possibility of deciding on the hospital themselves are investigated. Methods: The working hypotheses are tested with primary data from a cross-sectional survey. The primary data collection is based on questionnaire-based interviews on 1925 patients from 46 departments in 17 different hospitals in 5 different regions of North Rhine-Westphalia and 1 region of Rhineland-Palatinate and includes 11 medical disciplines that accounted for 91.9% of total full inpatient hospitalisations in Germany in the survey year 2012. These are internal medicine, surgery, gynecology, obstetrics, pediatrics, psychiatry, orthopedics, neurology, urology, ENT and geriatrics. For the present working hypotheses, patients are divided into 3 subsamples according to their health status in (1.) ill patients, (2.) healthy patients, and (3.) parents of pediatric patients. In addition, the subsample of (4.) ill gynecological female patients is isolated from the subsample of ill patients. Data will be analysed descriptively statistically and inferentially using chi-square test, t-test, one-way analysis of variance (ANOVA), and logistic regression analyses. Due to multiple testing, the Bonferroni-corrected significance level is p<0.0007. Results: The patients in all analysis groups largely decide on the hospital themselves. The proportion among healthy patients is nevertheless higher than that of parents and again higher than that of ill patients. It can be seen that the time before admission has a clear influence on the possibility to decide about the hospital by oneself. Other factors such as age, speciality or migration background only play a role in the group of ill patients and leave the healthy patients and parents uninfluenced. The own hospital knowledge is the most important source of information and the most important decision criterion for the ill patients, whereby specialty-specific differences are found in the order of the sources of information and decision criteria. These differences are only slight between women and men with the disease. For the healthy patients, the relatives are most important in the decision-making process. Parents of paediatric patients, like ill patients, draw on their previous experience, but more often include the doctors' behaviour towards their children as a decision criterion. Quality indicators play a subordinate role overall, but are taken into account significantly more often by healthy patients and parents than by ill patients. Corresponding health-related differences can also be seen in the comparison of ill patients in gynaecology with healthy patients in obstetrics. Thus, the healthy obstetrics patients decide more often on the hospital themselves, inform themselves more and use additional sources of information such as information events and the Internet, whereas the ill gynaecology patients make their decision on the basis of their own previous experience. Discussion: The behaviour of patients in choosing a hospital can be described overall as a socially oriented decision-making process based on trust and taking place in direct contact with caregivers. With increasing severity of the disease, patients want to be less involved in decisions and instead hand them over to trusted persons, as they are in an exceptional situation psychologically and physically. Thus, the better state of health enables the healthy patients and the parents to include objective quality criteria in the decision. Consequently, the state of health can be assumed to be a decisive factor influencing the choice of hospital. In the case that ill patients decide for themselves, they usually fall back on their own experiences that they were able to gather due to their illness, whereas healthy patients counter the lack of experience with an increased search for information. Parents of paediatric patients also have hospital experience due to the illness of their own child, which they take into account in the decision-making process. The differences between patients in the individual specialties are reflected in their different behaviour when choosing a hospital. The study of the ill women and men shows similar hospital choice behaviour without indications of pronounced gender-related differences. Accordingly, the influence of the speciality, the time before admission and the age of being able to decide on the hospital themselves is cross-gender. Conclusion: Hospital choice is relationship- and experience-based for both ill and healthy patients and parents of paediatric patients. Nevertheless, there are differences between the analysis groups. Ill patients are less likely to decide on the hospital themselves than parents of paediatric patients or healthy patients. They also consider a smaller number of information sources and decision criteria. Healthy patients inform themselves the most and comparatively often include objective criteria in their decision. Parents of paediatric patients take the doctor-patient relationship into account in particular and their behaviour lies between that of healthy and that of ill patients. There are subject-specific differences in the consideration and sequence of information sources and decision criteria. There are hardly any gender-specific differences. The patients in the field of gynaecology and obstetrics reflect the health-related differences without gender differences for women.