Abstract
This PhD thesis comprises three distinct papers addressing patient expectations of primary care. The objective of the thesis was to produce new knowledge about what patients want from their primary care experience and how these preferences can have an impact on ratings and choice of primary care doctor. The context for all three papers is the U.S. health care system. Utilizing patient narrative data, the first paper examines what patients state as their expectations when given the opportunity to express this in their own words. It further examines whether certain patient expectations are predictive of the overall rating that patients give their doctor. Results show that patients frequently state expectations that go beyond topics that are typically measured in standard patient experience surveys. While patients frequently report their expectations being met, this is not always the case. Some expectations appear to be predictive of whether a patient will give their provider a high overall rating, even in the presence of measures controlling for a patient’s actual experience of care. The second and third paper of this thesis utilize data collected in an experiment to study consumer behavior in the presence of doctor-level quality information. The second paper investigates how consumers rate 10 doctor attributes before and after exposure to a mock website reporting data on doctor performance. The study examines how patients potentially shift their ratings of the importance of certain doctor attributes following this exposure. The findings show that consumers do shift their perspective on what attributes are important in a doctor, but that where these shifts occur are related to a consumer’s tendencies concerning decision-making regret, style and skill. In the third paper, the importance ratings of three doctor attributes in particular (namely, reputation, safety and technical quality) are studied to determine whether consumers go on to then choose a doctor concordant with their preferences. The findings show that consumers appear responsive to performance information when making doctor choices. However, consumers’ ability to make concordant choices varies based on how confident they are in managing their health care and their style of decision-making.