Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

Vision of People Picking Providers Based on Price and Quality Information Far from Reality

News Release
Dec. 4, 2008

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Despite myriad initiatives to encourage people to use health care price and quality information, most Americans still rely on word-of-mouth and physician recommendations to choose health providers, according to a national study released today by the Center for Studying Health System Change (HSC) and funded by the California HealthCare Foundation.

While sponsors of health care price and quality transparency initiatives often identify all consumers as their target audiences, the true audiences for these programs are much more limited, the study found.

In 2007, only 11 percent of American adults looked for a new primary care physician, 28 percent needed a new specialist physician and 16 percent underwent a medical procedure at a new facility, according to findings from HSC’s 2007 Health Tracking Household Survey, a nationally representative survey containing information on 13,500 adults. The survey had a 43 percent response rate.

"Most Americans still rely on information from friends and family when choosing a primary care physician, and few Americans actively shop or consider price or quality information—especially when choosing specialists or facilities for medical procedures," said Ha T. Tu, M.P.A., an HSC senior researcher and coauthor of the study with Johanna R. Lauer, an HSC health research assistant. HSC is a nonpartisan health policy research organization funded in part by the Robert Wood Johnson Foundation.

When selecting new primary care physicians, half of all consumers relied on word-of-mouth recommendations from friends and relatives, but many also used doctor recommendations (38%) and health plan information (35%), the study found. Nearly two in five used multiple information sources when choosing a primary care physician, but when choosing specialists and facilities for medical procedures, most consumers relied exclusively on physician referrals, according to the study.

The study’s findings are detailed in a new HSC Research Brief—Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice—available here.

Other key findings include:

• Use of online provider information was low, ranging from 3 percent for consumers undergoing procedures to 7 percent for consumers choosing new specialists to 11 percent for consumers choosing new primary care physicians.
• Approximately 25 million adults—more than one in 10 adults—reported looking for a new primary care physician at some point in the previous 12 months. Seventeen million of these adults found a new PCP, while the remaining 8 million did not. Among the 17 million who found a new primary care physician in the past year, half relied on recommendations from friends and relatives, and more than one in four used such recommendations as their only information source.
• Almost 63 million adults—nearly three in 10—said they needed a new specialist in the previous year, with 46 million actually seeing a new specialist. Almost seven in 10 of the 46 million relied on referrals from their primary care physician to find a specialist, with almost six in 10 relying exclusively on this source. One in five used recommendations from friends and relatives, and only 15 percent used multiple sources of information. People with chronic conditions and those in fair or poor health were more likely to rely solely on their primary care physicians’ referrals, while younger and more-educated consumers were more likely to turn to other sources, including the Internet and health plan information.
• About 35 million adults—nearly one in six—reported undergoing a medical procedure at a new facility in the past year. In choosing facilities for procedures, consumers were even more reliant on physician guidance. Nearly three in four consumers who had procedures relied on the referral of the physician performing the procedure; almost all of these consumers used no other source of information. Alternative information sources were used by relatively few consumers, and only one in 12 used multiple information sources when choosing a facility. Older people and those with chronic conditions were more likely to rely solely on their physicians’ referrals in choosing a facility for a procedure.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.