Is it that people love a good movie selection, or do they take the movies to be the best available signal of hospital quality?
Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital’s demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.
Here is the paper. The ungated copy is here. Here is a recent article of relevance:
When the Sacred Heart Medical Center at RiverBend opens in Springfield, Ore., in August 2008, patients and their families will enter a hospital surrounded by wetlands and Douglas firs. Inside, they’ll encounter multiple fireplaces, coffee shops and visitors’ lounges.
"As you come to the hospital, you’ll be greeted warmly as you enter, much as you would by a concierge at a hotel," says Adam Kerner, an executive architect with Anshen + Allen, who partnered on RiverBend with an outside architect whose previous experience had been in designing resorts…
Gerard van Grinsven, president of the Henry Ford West Bloomfield Hospital now under construction in suburban Detroit, says area hospital executives were surprised when he was hired away from hotelier Ritz-Carlton in 2006. Up to then, his two-decade career had been exclusively in hotels and resorts.
But skepticism soon gave way to curiosity and competitiveness, van Grinsven says. In fact, Beaumont Hospitals in nearby Royal Oak, Mich., hired a Ritz-Carlton executive as their director of hospitality a short while later.
Van Grinsven is introducing a bit of the Ritz-Carlton flair to the new hospital, adding touches like mini-hotel rooms for visitors as well as healthy cooking classes for the surrounding community. The facility, which opens in July 2008, will include larger-than-normal emergency patient rooms–roughly 150 square feet–to create more space for visitors, a result of design sessions that included input from patients, nurses and doctors.
What this goes to show is that patients have very little idea how to go about evaluating the quality of medical care. In the absence of that information, they view amenities as a signal of prestige and therefore quality medicine. However as mediocre hospitals compete on the hospitality front, this signal becomes degraded.
It is highly unlikely that a patient facing life-or-death decisions will view the fawning of the staff as a significant deciding factor – unless he has little information about the far more important quality of medical care.
we paid an extra $750/day (not covered by insurance) for a private room after my son’s birth. i’m sure this is a big money cow for the hospital, but it was well worth it from our point of view and i’m sure we would do it again.
my wife had (long-planned) surgery once before with a two night stay in the hospital and she had really crappy nursing care afterward. if given the opportunity i would certainly have paid out of pocket (at least $1000/night, maybe more) for better care and/or more privacy and/or the ability to stay overnight in the room on a bed, and i’m sure others would as well.
Hospitals are loaded with infectious microbes… and are very, very difficult to keep sanitary. Hospital-acquired infections kill patients by the tens of thousands each year.
Hotel style furnishings (carpets, drapes, upholstered furniture, artwork, etc.) make the the cleaning task very much harder.
Hard floors, stark walls & furnishings, minimized square footage, and limited foot traffic are necessary to efficiently manage hospital sanitation.
Most people should avoid hospitals– and get out as soon as practical if required there as a patient or visitor.
One can enjoy the amenities of luxury hotels after surviving the hospital environment. IMO most would prefer non-infection over fancy digs if they understood the risks.
Does this extend to the billing department? Sending people threatening letters, after they have paid their portion of the bill, does not scream hospitality. The patient can’t control how long the insurance company takes to pay their part of the bill.
–In the absence of that information, they view amenities as a signal of prestige and therefore quality medicine. However as mediocre hospitals compete on the hospitality front, this signal becomes degraded.
I’m not sure the signal is degraded. maybe those good at hospitality are precisely those who have good process in place, good oversight, good response time, with employees at all levels empowered to fix something. those sure look like the same features needed to reduce medical mistakes, examine inefficient procedures, and respond to an emergent condition rapidly. and would a hospital who was mediocre at care really manage exquisite hospitality? heck, if the only hospitality improvement a hospital made was to let patients sleep through the night without interruption, that alone could improve outcomes.
Virginia: Unfortunately, with most hospitals (at least in my state) never making enough NPR (Net Patient Revenue) to break even-and barely getting there with government and private grants and subsidies, often provided on a reimbursement of “legitimate” cost or “need” basis-the fineries of the physical plant will always be of lesser priority-unless it affects the JCAHO accreditation or state health department inspection.
By the way, the “Joint Commission” just released a report about the hospital of the future
http://www.jointcommission.org/NR/rdonlyres/1C9A7079-7A29-4658-B80D-A7DF8771309B/0/Hosptal_Future.pdf
Not suprisingly, much of their concerns were vacant abstractions or obviously PC things like being “green” that should be a secondary (if at all) concern to providing a well-maintained facility that supports the effective and efficient delivery of healthcare.
I’ll make a bet- the influential healthcare/hospital industries will be using this document as a template to make a play to expand/divert the “infrastructure” spending spree promised by Pres. Elect Obama to them.
“clinical quality as measured by pneumonia mortality.”
Is pneumonia mortality a legitimate measure of clinical quality? Is pneumonia mortality higher primarily because of poor care, or because those likely to die of pneumonia are more likely to go to particular hospitals?
Cotton M. Lindsay, my dissertation advisor at Clemson, gave one explanation in “A Theory of Government Enterprise”, Journal of Political Economy (JPE), 1976. His theory was that patients valued both the getting well part (strictly hospital services, that is) and the staying in a nice place part (the hotel services; I think he even called it that), while the politicians who oversaw the VA hospitals valued only the former. So, private hospitals delivered on both. Meanwhile the VA hospitals did just as good a job of making you healthy as the private ones.
An alternative explanation (Klein and Leffler, JPE, 1981, “The Role of Market Forces in Assuring Contractual Performance”) would be that the plush stuff signals the quality of care. Nice couches and fireplaces show that the stay is going to cost a lot of money. The patients figure maybe there’s a good reason for that.
Just to add two cents – I actually worked with the architect for River Bend, and it was supported by the concept of Evidenced Based Design.
In essence, a more aesthetic and pleasant environment (for staff, visitors and patients) leads to better outcomes for all.
Hospitals are scary places for many people – these sorts of amenities go a long way to removing some of that fear.
http://www.healthdesign.org/ and http://en.wikipedia.org/wiki/Evidence-based_design have quite a bit more information on the topic.
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