Giving Consumers of British Public Services More Choice: What can be Learned from Recent History?

Perri,

doi:10.1017/s0047279402006980

Cited by 82 publications

(15 citation statements)

References 42 publications

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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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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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“…The interest in introducing choice mostly builds on two fundamental arguments [5,6], mirroring views of choice as an end in itself or a means to an end [7]:…”

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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“…The Conservative governments of Margaret Thatcher and John Major pushed for greater competition for public services without necessarily providing greater choice for consumers. Tony Blair's government increased choice (6, 2003). A number of aspects of the choice‐driven public services may be queried.…”

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confidence: 99%

The Three Exit, Three Voice and Loyalty Framework: A Test with Survey Data on Local Services

Dowding

John

2007

Political Studies

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The article presents a modified Hirschman framework with three types of exit: moving location; moving from the public to a private sector provider; and moving between public sector providers; and three types of voice: private voice (complaining about private goods); voting; and collective action. Seven hypotheses are generated from this framework. The article then presents evidence from the first round of an online survey examining citizen satisfaction with public services and the relationship between exit and voice opportunities. We find dissatisfied people are more likely to complain privately, vote and engage in other forms of collective participation; but only a weak relationship exists between dissatisfaction and geographical exit. We find some evidence that the exit–voice trade‐off might exist as more alert consumers are more likely to move from the public to the private sector and those ‘locked in’ are more likely to complain than those who have outside options. Overall the results tend to corroborate the hypotheses drawn from the modified Hirschman framework.

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Giving Consumers of British Public Services More Choice: What can be Learned from Recent History?

Cited by 82 publications

References 42 publications

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

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

The Three Exit, Three Voice and Loyalty Framework: A Test with Survey Data on Local Services

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