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Harold S. Luft, PhD; Deborah W. Garnick, ScD; David H. Mark, MD, MPH; Deborah J. Peltzman; Ciaran S. Phibbs, PhD; Erik Lichtenberg, PhD; Stephen J. McPhee, MD

JAMA. 1990;263(21):2899-2906.

Abstract
In recent years, much information has been provided to the public and to physicians about hospital quality measured in terms of patient outcomes. To examine if, before these public data releases, quality influenced the attractiveness of a hospital to referring or admitting physicians and to patients, we estimated the influences of quality, charges, ownership, and distance on the choice of hospitals for patients with seven surgical procedures and five medical diagnoses in hospitals in three geographic areas in California in 1983. Greater distance and public or proprietary ownership consistently reduced the likelihood of selection while medical school affiliation increased the likelihood of selection. For five of seven surgical procedures and two of five medical diagnoses, hospitals with poorer than expected outcomes attracted significantly fewer admissions. The reverse held for two surgical procedures and one medical diagnosis. The results suggest that quality played an important role in choices among hospitals even before explicit data were widely available.

(JAMA. 1990;263:2899-2906)

Author Affiliations
From the Institute for Health Policy Studies, University of California, San Francisco (Drs Luft and McPhee and Ms Peltzman); the School of Public Health, Harvard University, Boston, Mass (Dr Garnick); Department of Family Medicine, Medical College of Wisconsin, Milwaukee (Dr Mark); Division of Health Policy and Management, School of Public Health, Columbia University, New York, NY (Dr Phibbs); and Department of Agricultural and Resource Economics, University of Maryland, College Park (Dr Lichtenberg).

Footnotes
Reprint requests to Institute of Health Policy Studies, University of California, San Francisco, 1326 Third Ave, San Francisco, CA 94141-0936 (Dr Luft).

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