Ranking Sources of Hospital Quality Information for Orthopedic Surgery Patients: Consequences for the System of Managed Competition

  • Romy Evelien BesEmail author
  • Bernard van den Berg
Short Communication



Healthcare quality information is crucial for the system of managed competition. Within a system of managed competition, health insurers can selectively contract care providers and are allowed to channel patients towards contracted providers. The idea is that insurers have a stronger bargaining position compared to care providers when they are able to channel patients. In the Dutch system of managed competition that was implemented in 2006, channelling patients to preferred providers has not yet been very successful. Empirical knowledge of which sources of hospital quality information they find important may help us to understand how to channel patients to preferred providers.


The objective of this survey was to measure how patients rank various sources of information when they compare hospital quality in a system of managed competition.


A written survey was conducted among clients of a large Dutch health insurance company. These clients underwent orthopedic surgery on the hip or knee no longer than 12 months ago.


Two major players within a system of managed competition—health insurers and the government—were not seen as important sources of hospital quality information. In contrast, own experience and general practitioners (GPs) were seen as the most important sources of hospital quality information within the Dutch system of managed competition.


Health insurers should take the main finding—that GPs are the most important source of hospital quality information—into account when they contract care providers and develop strategies for channeling patients towards preferred providers. A well-functioning system of managed competition will benefit patients, as it involves incentives for care providers to increase healthcare quality and to produce at the lowest cost per unit of quality.


Quality Information Health Insurer Discrete Choice Experiment National Ranking Prefer Provider 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to conduct this study or to prepare this manuscript. The authors declare that they have no conflicts of interest relevant to the content of this article. We gratefully acknowledge the comments and suggestions of four anonymous reviewers and those of the Associate Editor Tim Wrightson. RB was responsible for the development of the survey, data collection, and data analysis. Both authors interpreted and discussed the results and their implications, and drafted and wrote the article. RB is the guarantor for the overall content.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.NIVEL, Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
  2. 2.Centre for Health Economics, Alcuin ‘A’ BlockUniversity of YorkYorkUK

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