Word-of-Mouth, Physician Referrals Drive Primary Care Physician, Specialist Choices

Most US adults still rely on word-of-mouth and physician recommendations when selecting health care providers despite an increase in health care price and quality transparency initiatives, according to findings of a study by the Center for Studying Health System Change (HSC) released on December 4. HSC interviewed 13,500 adults for its nationally representative 2007 Health Tracking Household Survey. The study was funded by the California HealthCare Foundation.

HSC reported that in 2007, 25.2 million adults (11.4%) looked for a new primary care physician (PCP). Among these adults, 17.1 million (7.7%) found one, while 8.1 million (3.7%) did not. Of those who found a new PCP in the past year, half (50.3%) relied on word-of-mouth recommendations from friends and relatives, and more than 1 in 4 (26.9%) used such recommendations as their only information source (Figure). Many adults also relied on physician recommendations (38.1%) and health plan information (34.7%) when choosing a new PCP. Just 10.8% of adults used online resources.

Of the 62.6 million adults (28.4%) who said they needed a new specialist in 2007, 46.3 million (21%) actually saw a new specialist. Almost 7 in 10 (68.5%) of the 46.3 million relied on referrals from their PCP to find a specialist, with almost 6 in 10 (58.2%) using this source exclusively. Nearly 1 in 5 (19.9%) followed recommendations of friends and relatives, 10.5% used health plan information, and 6.8% accessed the Internet for provider information.

Approximately 35 million adults (15.9%) reported undergoing a medical procedure at a new facility in the past year. When selecting such facilities, study participants were even more reliant on the guidance of their PCPs. About 3 in 4 participants (73.9%) who had procedures relied on the referral of the physician performing the procedure; almost all of these participants (68.6%) used no other source of information when choosing a facility. Only 10% of participants relied on friends and relatives for recommendations, 7% used health plan information, and just 2.5% turned to the Internet for information.

While sponsors of health care cost and transparency initiatives often identify all consumers as their target audiences, the true audiences for such programs are much more limited, the study authors found. “When choosing a PCP, specialists, or facilities for medical procedures, few Americans actively shop or consider price or quality information,” concluded Ha T. Tu, MPA, HSC senior researcher.

The full report is available at http://hschange.org/CONTENT/1028/1028.pdf.