Choice policies in Northern European health systems

Abstract

This paper compares the introduction of policies to promote or strengthen patient choice in four Northern European countries - Denmark, England, the Netherlands and Sweden. The paper examines whether there has been convergence in choice policies across Northern Europe. Following Christopher Pollitt's suggestion, the paper distinguishes between rhetorical (discursive) convergence, decision (design) convergence and implementation (operational) convergence (Pollitt, 2002). This leads to the following research question for the article: Is the introduction of policies to strengthen choice in the four countries characterised by discursive, decision and operational convergence? The paper concludes that there seems to be convergence among these four countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). It appears that the institutional context and policy concerns such as waiting times have been important in affecting the timing of the introduction of choice policies and implementation, but less so in the design of choice policies. An analysis of the impact of choice policies is beyond the scope of this paper, but it is concluded that further research should investigate how the institutional context and timing of implementation affect differences in how the choice policy works out in practice.

Determinants of patient choice of healthcare providers: a scoping review

“…Important reasons for promoting patient choice were to reduce waiting times and to encourage competition between providers. Competition was expected to make care more responsive to patients and, among other things, improve efficiency (including cost decreases), quality and (in the UK) equity of healthcare [2-4]. In the Netherlands in 2006 for example, a demand-driven healthcare system was implemented to enhance competition between providers as a means of helping to achieve these goals.…”

Choice of hospital: Which type of quality matters?

“…Many European healthcare systems have recently extended patients' right to choose their provider of elective hospital care (Vrangbaek et al., 2012). One of the aims is to encourage hospitals to compete for patients by improving quality (Besley and Ghatak, 2003).…”

Are patients’ preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations

“…These choices would, in theory, be based on comparing information on quality and price [4]. This should enhance competition between providers [2,3] and, ultimately, result in a more personalised, responsive, efficient, and higher quality health service [3,5]. This line of reasoning originates from the neoclassical microeconomic theory [6].…”