A Fair Range of Choice: Justifying Maximum Patient Choice in the British National Health Service

Wilmot, Stephen

doi:10.1007/s10728-006-0032-6

Cited by 11 publications

(10 citation statements)

References 36 publications

(24 reference statements)

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“…Even if two individuals have the same disability, they might perceive different needs [64]. Elderly clients vary a good deal with regard to their health definitions, preferences, desires and priorities [75]. These aspects will all influence the determination of the desired state or goal an individual elderly client wants to reach, and this makes the goal in health and well-being highly personal [32].…”

Section: Needs: Diverse and Subject To Changementioning

confidence: 99%

“…On the supply-side, services in housing, welfare and care can be better tuned to the diversity in needs when the available range of options in service supply increases [e.g. 16,73,75]. Only then will clients be able to fulfil their needs with care and services of their preference, given their personal background, taste and circumstances.…”

Section: Conversion To Daily Practice: Implications For Providersmentioning

confidence: 99%

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Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management

2008

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Practical implementation of notions such as patient-orientation, clientcentredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation's policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. 123Health Care Anal (2009) 17:68-84 DOI 10.1007 Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.

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Section: Needs: Diverse and Subject To Changementioning

confidence: 99%

Section: Conversion To Daily Practice: Implications For Providersmentioning

confidence: 99%

Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management

2008

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“…In general the interest in introducing choice is based on two fundamental arguments [5,6]: an ideological viewpoint, which views an opportunity for citizens to choose a supplier as an objective in itself, as it strengthens personal freedom [7,8], and an instrumental viewpoint, which emphasizes that the public sector can improve its effectiveness, quality, equity in access to care and responsiveness by introducing or strengthening choice, e.g. an opportunity for patients to choose a health care provider [2,4].…”

Section: Introductionmentioning

confidence: 99%

Which factors decided general practitioners’ choice of hospital on behalf of their patients in an area with free choice of public hospital? A questionnaire study

Birk

Henriksen

2012

BMC Health Serv Res

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BackgroundParts of New Public Management-reforms of the public sector depend on introduction of market-like mechanisms to manage the sector, like free choice of hospital. However, patients may delegate the choice of hospital to agents like general practitioners (GPs). We have investigated which factors Danish GPs reported as decisive for their choice of hospital on behalf of patients, and their utilisation of formal and informal data sources when they chose a hospital on behalf of patients.MethodsRetrospective questionnaire study of all of the 474 GPs practising in three counties which constituted a single uptake area. Patients were free to choose a hospital in another county in the country. The GPs were asked about responsibility for choice of the latest three patients referred by the GP to hospital; which of 16 factors influenced the choice of hospital; which of 15 sources of information about clinical quality at various hospitals/departments were considered relevant, and how often were six sources of information about waiting time utilised.ResultsFifty-one percent (240 GPs) filled in and returned the questionnaire. One hundred and eighty-three GPs (76%) reported that they perceived that they chose the hospital on behalf of the latest referred patient. Short distance to hospital was the most common reason for choice of hospital.The most frequently used source of information about quality at hospital departments was anecdotal reports from patients referred previously, and the most important source of information about waiting time was the hospitals’ letters of confirmation of referrals.ConclusionsIn an area with free choice of public hospital most GPs perceived that they chose the hospital on behalf of patients. Short distance to hospital was the factor which most often decided the GPs’ choice of hospital on behalf of patients. GPs attached little weight to official information on quality and service (waiting time) at hospitals or departments, focusing instead on informal sources like feedback from patients and colleagues and their experience with cooperation with the department or hospital.

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“…Providing citizens with an opportunity to choose a supplier is an objective in itself, as it strengthens personal freedom [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

Birk

Gut

Henriksen

2011

BMC Health Serv Res

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BackgroundResearch on patients' choice of hospital has focused on inpatients' rather than outpatients' choice of provider. We have investigated Danish outpatients' awareness and utilisation of freedom of choice of provider; which factors influence outpatients' choice of hospital, and how socio-demographic variables influence these factors in a single uptake area, where patients were free to choose any public hospital, where care was provided free at the point of delivery, and where distance to the closest hospitals were short by international standards.MethodsRetrospective questionnaire study of 4,232 outpatients referred to examination, treatment, or follow-up at one of nine somatic outpatient clinics in Roskilde County in two months of 2002, who had not been hospitalised within the latest 12 months. The patients were asked, whether they were aware of and utilised freedom of choice of hospital.ResultsFifty-four percent (2,272 patients) filled in and returned the questionnaire. Forty-one percent of respondents were aware of their right to choose, and 53% of those patients utilised their right to choose. Awareness of freedom of choice of provider was reported to be especially high in female outpatients, patients with longer education, salaried employees in the public sector, and in patients referred to surgical specialties. Female outpatients and students were especially likely to report that they utilised their right to choose the provider. Short distance was the most important reason for outpatients' choice, followed by the GP's recommendations, short waiting time, and the patient's previous experience with the hospital.ConclusionsOutpatients' awareness and utilisation of free choice of health care provider was low. Awareness of freedom of choice of provider differed significantly by specialty and patient's gender, education and employment. Female patients and students were especially likely to choose the clinic by themselves. Most outpatients chose the clinic closest to their home, the GP's recommendation and short waiting time being the second and third most important factors behind choice.

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A Fair Range of Choice: Justifying Maximum Patient Choice in the British National Health Service

Cited by 11 publications

References 36 publications

Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management

Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management

Which factors decided general practitioners’ choice of hospital on behalf of their patients in an area with free choice of public hospital? A questionnaire study

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

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