Are religiously affiliated hospitals more than just nonprofits? A study on stereotypical patient perceptions and preferences.

Recent research on patients' perceptions of different hospitals predominantly concentrates on whether hospitals are nonprofit or for-profit. Nonprofit hospitals can be subdivided into hospitals that are affiliated with a religious denomination and those that are not. Referring to the stereotypic content model, this study analyzes patients' perceptions of religious hospitals based on the factors of warmth, competence, trustworthiness and Christianity. Using a survey of German citizens (N = 300) with a one-factorial between-subject design (for-profit vs. nonprofit vs. religious nonprofit), we found that religious affiliation increases the perceptions of hospitals' trustworthiness and attractiveness. The study indicated that patients' perceptions of nonprofit hospitals with a religious affiliation differ from patients' beliefs about nonprofit hospitals without a religious affiliation, implying that research into ownership-related differences must account for hospital subtypes. Furthermore, religious hospitals that communicate their ownership status may have competitive advantages over those with a different ownership status.

The patient perspective of clinical training-an empirical study about patient motives to participate.

This study introduces a comprehensive model to explain patients' prosocial behavioral intentions to participate in clinical training. Using the helping decision model, the authors analyze the combined impact of factors that affect participation intentions. The model includes intrapersonal and interpersonal appraisals triggered by an awareness of the societal need for clinical training as a practical part of medical education. The results of our empirical study (N=317) show that personal costs and anxiety as negative appraisals and a warm glow as a positive appraisal affect participation intentions and fully mediate the effect of the patient's awareness of the societal need. The study results indicate that communication strategies should address patient beliefs about negative personal consequences of participation rather than highlighting the societal need for practical medical education related to clinical training. Based on the results, medical associations could develop guidelines and provide training for physicians on how to motivate patients to participate in clinical training, resulting in more patient-centered standardized consent discussions.

Applying the concept of consumer confusion to healthcare: development and validation of a patient confusion model.

As patient autonomy and consumer sovereignty increase, information provision is considered essential to decrease information asymmetries between healthcare service providers and patients. However, greater availability of third party information sources can have negative side effects. Patients can be confused by the nature, as well as the amount, of quality information when making choices among competing health care providers. Therefore, the present study explores how information may cause patient confusion and affect the behavioral intention to choose a health care provider. Based on a quota sample of German citizens (n = 198), the present study validates a model of patient confusion in the context of hospital choice. The study results reveal that perceived information overload, perceived similarity, and perceived ambiguity of health information impact the affective and cognitive components of patient confusion. Confused patients have a stronger inclination to hastily narrow down their set of possible decision alternatives. Finally, an empirical analysis reveals that the affective and cognitive components of patient confusion mediate perceived information overload, perceived similarity, and perceived ambiguity of information.

Who chooses, who uses, who rates: the impact of agency on electronic word-of-mouth about hospitals stays.

BACKGROUND: Patients' agents rather than patients themselves often choose hospitals and rehabilitation centers and evaluate inpatient stays. Thus, online reviews of a hospital may reflect a service experience the patient is not responsible for in two ways. First, a patient may evaluate a hospital that a physician as agent has selected, although he still received the service and is qualified to evaluate it. Second, relatives who may not be directly involved in the inpatient stay may write online reviews, which reflect their own experiences and evaluations. PURPOSE: The study analyzes patient satisfaction data in online hospitals reviews and patients' underlying motives for electronic word-of-mouth according to the type of hospital admission and the perspective of the reviewer. METHODOLOGY: The study uses a sample of 822 reviews from an online platform for hospital reviews and primary data generated by an online survey distributed to the writers of these reviews. FINDINGS: Patients who choose a hospital themselves write more positive online reviews than those with an other-directed choice. Relatives' online reviews more often deal with negative hospital experiences and are more likely to reflect a desire for retaliation. PRACTICE IMPLICATIONS: The study results imply that medical care centers (hospitals and rehabilitation facilities) should pay more attention to agency by focusing on the needs and perceptions of relatives who often act as the critical voice of patients in electronic word-of-mouth behavior.

How patients choose hospitals: using the stereotypic content model to model trustworthiness, warmth and competence.

In many countries, policy initiatives force the implementation of demand-driven healthcare systems to encourage competition among providers. When actively choosing hospitals, consumers can compare data on the quality of hospital performance among providers. However, patients do not necessarily take full advantage of comparative quality information but instead use a number of readily available proxies to evaluate provider trustworthiness. According to the stereotypic content model, organizational trustworthiness is built on stereotypical perceptions of hospitals' competence and warmth, reflected by visible hospital characteristics such as ownership and teaching status, and size. We introduce a theoretical framework on stereotypic quality perceptions that brings together fragmented findings in health services research on patient quality expectations of hospital characteristics. The model provides a basis for further research and recommendations for improved hospital communication strategies. The study suggests that researchers as well as hospital management should pay more attention to stereotypical patient quality perceptions and their impact on hospital choice to understand patients' quality evaluations better.

The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population.

The potential of secondary prevention measures, such as cancer screening, to produce cost savings in the healthcare sector is a controversial issue in healthcare economics. Potential savings are calculated by comparing treatment costs with the cost of a prevention program. When survivors' subsequent unrelated health care costs are included in the calculation, however, the overall cost of disease prevention rises. What have not been studied to date are the secondary effects of fatal disease prevention measures on social security systems. From the perspective of a policy maker responsible for a social security system budget, it is not only future healthcare costs that are relevant for budgeting, but also changes in the contributions to, and expenditures from, statutory pension insurance and health insurance systems. An examination of the effect of longer life expectancies on these insurance systems can be justified by the fact that European social security systems are regulated by the state, and there is no clear separation between the financing of individual insurance systems due to cross-subsidisation. This paper looks at how the results of cost-comparison analyses vary depending on the inclusion or exclusion of future healthcare and non-healthcare costs, using the example of colorectal cancer screening in the German general population. In contrast to previous studies, not only are future unrelated medical costs considered, but also the effects on the social security system. If a German colorectal cancer screening program were implemented, and unrelated future medical care were excluded from the cost-benefit analysis, savings of up to 548 million euros per year would be expected. The screening program would, at the same time, generate costs in the healthcare sector as well as in the social security system of 2,037 million euros per year. Because the amount of future contributions and expenditures in the social security system depends on the age and gender of the recipients of the screening program (i.e. survivors of a typically fatal condition), the impact of age and gender on the results of a cost-comparison analysis of colorectal cancer screening are presented and discussed. Our study shows that colorectal cancer screening generates individual cost savings in the social security system up to a life expectancy of 60 years. Beyond that age, the balance between a recipient's social security contributions and insurance system expenditure is negative. The paper clarifies the relevance of healthcare costs not related to the prevented disease to the economic evaluation of prevention programs, particularly in the case of fatal diseases such as colorectal cancer. The results of the study imply that, from an economic perspective, the participation of at-risk individuals in disease prevention programs should be promoted.