• CarlinCaroline SCSMedica Research Institute, MR-CW295, PO Box 9310, Minneapolis, MN 55440. E-mail: caroline.carlin@medica.com., John Kralewski, and Megan Savage.
• Medica Research Institute, MR-CW295, PO Box 9310, Minneapolis, MN 55440. E-mail: caroline.carlin@medica.com.
• Am J Manag Care. 2013 Aug 1; 19 (8): e293-300.

ObjectivesWe explored the process of physician selection, focusing on selection of surgeons for knee and hip replacement to increase the probability of a new relationship, making cost and quality scorecard information more relevant.Study DesignWe collected data using a mailed survey sent to patients with knee or hip replacement surgery shortly after March 1, 2010. This time period followed a period of publicity about the new cost and quality scorecard.MethodsWe used multivariate probit models to predict awareness of the scorecard and willingness to switch providers. Multinomial logit methods were used to predict the primary factor influencing the choice of surgeon (physician referral, family or friend referral, surgeon location, previous experience with the surgeon, or other).ResultsInternet access and higher neighborhood incomes are associated with an increased probability of being aware of the scorecards. Male patients and patients with Internet access or in highly educated neighborhoods are more likely to be willing to switch providers for a reduced copay. Urban residents are more likely to rely on physician referrals, and rural patients on family/friend referrals when selecting a surgeon; Internet access reduces importance of surgeon location.ConclusionsAdditional research is needed to determine whether Internet access is causal in improved responsiveness to market information and incentives, or a proxy for other factors. In addition, we see evidence that efforts to improve healthcare quality and costs through market forces should be tailored to the patient's place of residence.

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