Patient Safety and Quality

Some patients choose safer hospitals when an insurer offers an incentive program

Researchers recently investigated whether patients will choose hospitals with excellent patient safety track records over other hospitals if their insurer provides financial incentives to go to the safer hospitals. They studied a large employer who offered a health insurance plan with a "hospital safety incentive" to two union groups: engineers and machinists. Under the safety incentive, the hospital copayments for union members or their family members would be waived if they were admitted to hospitals with good patient safety report cards in 2004, as measured by using the Leapfrog Group's safety leaps. Nonunion employees were not subject to the hospital safety incentive and served as a control group for the study. (The self-funded employer believed it would also benefit if use of a safe hospital results in fewer complications and shorter stays than an unsafe hospital.)

Patients affiliated with the engineers' union and who were admitted to the hospital with a medical diagnosis were nearly three times more likely than nonunion patients to choose a hospital that met the safety criteria after the safety incentive took effect. The machinists' union group, however, did not visit safer hospitals as frequently as the engineering group. The authors suggest that the engineers' higher education levels may have helped them understand the incentive more readily than the machinists. However, neither engineers nor machinists who needed surgery visited safer hospitals more frequently after the safety incentive when compared with their nonunion counterparts. This could be, in part, because only 18 percent of hospitals in that market were considered eligible for the incentive. That, coupled with the fact that admitting physicians, including surgeons, do not necessarily have staff privileges at every hospital, may explain the low rates of use.

The authors suggest that these types of incentives will continue to evolve as employers and insurers aim to receive greater value from their health care investments. This study was funded in part by the Agency for Healthcare Research and Quality (HS13680).

See "Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions," by Dennis P. Scanlon, Ph.D., Richard C. Lindrooth, Ph.D., and Jon B. Christianson, Ph.D., in the October 2008 HSR: Health Services Research 43(5), pp. 1849-1868.

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