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The Effects of Hospital Safety Scores, Total Price, Out-of-Pocket Cost, and Household Income on Consumers' Self-reported Choice of Hospitals

Duke, Christopher C. PhD*; Smith, Brad PhD; Lynch, Wendy PhD*; Slover, Michael MS*

doi: 10.1097/PTS.0000000000000146
Original Articles

Objectives The study measured the relative influence of the following 3 factors in consumers' choice of hospitals: (1) cost, (2) out-of-pocket cost, and (3) safety as measured by Leapfrog Hospital Safety Score letter grade.

Methods Two hospital-choice questions regarding a hypothetical medical procedure were administered to 2357 online respondents. In question 1, respondents were assigned a scenario in which hospital 1 grade (A through D), hospital 2 grade (B through F), and hospital 2 total cost (3 levels) were randomly varied across respondents. In all cases, hospital 2 had a lower safety grade than hospital 1, and hospital 1 cost was held constant. In question 2, scenarios varied out-of-pocket cost rather than total cost. Demographic characteristics, income level, health status, health literacy, and opinions about value were also measured.

Results On average, 94% and 88% of the respondents chose the safer hospital in questions 1 and 2, respectively. In all but 1 of 30 possible scenarios, where hospital 2 cost the individual $1000 less and was rated a B whereas hospital 1 was rated an A, respondents chose the safer hospital. Higher incomes, higher health literacy, and being female were associated with a stronger preference for hospital 1 (safer). There was a small effect suggesting that approximately 4% of the respondents selected a higher-cost hospital despite lower safety, but it was outweighed by predominant selections of the safer hospital.

Conclusions When shown Hospital Safety Score and cost information, consumers chose safer hospitals in 97% of cost and safety scenarios.

From the *Center for Consumer Choice in Health Care, Altarum Institute, Ann Arbor, Michigan; and †Health Systems and Services Research, Drexel University, Philadelphia, Pennsylvania.

Correspondence: Christopher C. Duke, PhD, Center for Consumer Choice in Health Care, Altarum Institute, 3520 Green Court, Suite 300, Ann Arbor, MI 48105 (e-mail:

The authors disclose no conflict of interest.

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