QuickTake: Nonelderly Adults Consider Cost of Care Very Important When Choosing a Physician


Laura Skopec and Sharon K. Long

February 26, 2016


Between September 2013 and September 2015, the uninsurance rate fell 7.2 percentage points, representing 14.3 million fewer Americans uninsured (Karpman and Long 2015). As the uninsured gain coverage and others move among plans, many will need to find new providers. Although research has assessed the role of insurance coverage, referrals and recommendations, ratings, and cost in provider choice (Hanauer et al. 2014; Harris 2003; Tu and Lauer 2008), which factors consumers consider most important to making their selection, particularly as insurance coverage rates have increased, remains unclear.


Accordingly, in the September 2015 round of the Health Reform Monitoring Survey we asked respondents, on a scale from very important to not at all important, how important the following factors would be if they were looking for a new doctor or other health provider today: Whether the doctor or other provider accepted your insurance; whether the doctor had a recommendation or referral from another doctor or other health care provider; whether the doctor had a recommendation from family or friends; the cost of the care from the doctor or other health care provider; the location of the doctor’s office or other health care provider’s office; and the rating of the doctor or other health care provider. For those indicating that location was somewhat or very important, a follow-up question narrowed the type of location to near home, near work, or near public transportation. For this analysis, we combined those who reported acceptance of insurance or cost of care as very important into a single category called “cost of care,” because out-of-pocket cost is driven by insurance coverage.


Overall, 79.9 percent of insured nonelderly adults felt that cost of care was very important when choosing a provider,1 followed by provider ratings (49.1 percent) and location (43.7 percent; data not shown). This pattern held across income groups, though the specific share of insured nonelderly adults considering each factor very important varied by income (figure 1).



Among insured adults who considered location very important, nearly all adults regardless of income would look for locations near where they live. Adults in families with income at or below 138 percent of the federal poverty level were more interested in provider offices near public transportation than those with higher incomes and less interested in locations near work (figure 2).



These results indicate that most insured nonelderly adults considered the cost of care to be a very important factor in choosing a new provider, and a broad array of other factors were considered very important by over one-third of respondents. When considering location, nearly all insured adults would choose provider locations near where they live; preference for locations near work or public transit varies by income. Finally, insured nonelderly adults placed greater emphasis on provider ratings than referrals or recommendations from other providers or family and friends, potentially indicating a robust market for broad dissemination of quality of care data. Additional data is needed to examine the underlying reasons for differences in provider selection factors by income, including possible effects of insurance type, health insurance literacy, or other factors.




Hanauer, David A., Kai Zheng, Dianne C. Singer, Achamyeleh Gebremariam, and Matthew M. Davis. 2014. “Public Awareness, Perception, and Use of Online Physician Rating Sites.” Journal of the American Medical Association 311 (7): 734–35.


Harris, Katherine M. 2003. “How Do Patients Choose Physicians? Evidence From a National Survey of Enrollees in Employment-Related Health Plans.” Health Services Research 38 (2).


Karpman, Michael, and Sharon K. Long. 2015. “QuickTake: Taking Stock: Gains in Health Insurance Coverage under the ACA Continue as of September 2015, but Many Remain Uninsured.” Washington, DC: Urban Institute.


Tu, Ha T., and Johanna Lauer. 2008. Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice. Washington, DC: Center for Studying Health System Change.


About the Series

This QuickTake is part of a series drawing on the Health Reform Monitoring Survey, a quarterly survey of the nonelderly population that explores the value of cutting-edge Internet-based survey methods to monitor the ACA before data from federal government surveys are available. Funding for the core Health Reform Monitoring Survey is provided by the Robert Wood Johnson Foundation and the Urban Institute. The authors are grateful to Stephen Zuckerman for helpful comments on this QuickTake.


For more information on the Health Reform Monitoring Survey and for other QuickTakes in this series, visit www.urban.org/hrms.


About the Authors


Laura Skopec is a research associate and Sharon K. Long is a senior fellow with the Urban Institute’s Health Policy Center.



1 Cost of care includes those who directly mentioned cost as well as those who said that acceptance of insurance was very important.

Urban Institute Robert Wood Johnson Foundation