Access, Choice and Travel: Implications for Health Policy

Abstract

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. 'Patient choice' policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of 'choice' might not necessarily be the 'local' provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients' access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio-economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients' willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

“…The multinomial regression analysis (Table 3) shows that people who live in city center and have higher level of income are strongly associated with membership in both free and enforced choice groups. These results are not surprising since often private providers are located in the urban areas and people with higher income have the higher probability of choosing private service (Burge et al, 2004;Mukamel et al, 2004;Lako & Rosenau, 2009;Exworthy & Peckham, 2010). Another outcome from the regression analysis (enforced choice vs negative choice and enforced choice vs free choice) indicates that with increasing service needs the people are more likely to be enforced to use the market-based care.…”

“…Usually, people act rationally while choosing their care service and the provider (Anell, 1997;Scott, 2000b;Fotaki, 2005;Robertson, 2009). However, rational thinking does not always support people's choice of providers; as rational choice requires adequate information about the service availability, mental ability to differentiate services and self-control to choose the service (Exworthy & Peckham, 2010;Kooreman & Prast, 2010). Older people find themselves often in a situation where they sense incapability of making rational choice (Albada & Triemstra, 2009;Victoor et al, 2012b).…”

“…Older people find themselves often in a situation where they sense incapability of making rational choice (Albada & Triemstra, 2009;Victoor et al, 2012b). People's choice can also be influenced by other factors rather than just by rational thinking, such as acceptability, affordability, availability, accessibility and accommodation (Pechansky and Thomas, 1981;Exworthy & Peckham, 2010;Nordgren & Ahgren, 2011). Furthermore, individuals' socio-economic and health status also play an important role in determining the service provider (Stoddart et al, 2002, Burge et al, 2004Mukamel et al, 2004;Lako & Rosenau, 2009;Exworthy & Peckham, 2010;Szebehely et al, 2012, Van Aerschot 2014.…”

‘What are you going to do, confiscate their passports?’ Professional perspectives on cross-border reproductive travel

“…This consumerist discourse is one that in the UK context has recently become significant in relation to publicly funded (NHS) as well as private healthcare and has been discussed as an important part of patient willingness to travel overseas for healthcare more generally (Exworthy & Peckham, 2006). In our participants' accounts, patients are discursively constructed as free agents, able to make choices to exercise their individual 'rights'.…”

Patient Cross-Border Mobility: New Findings and Implications in Spanish Regions

“…In this sense, several studies have analysed patient migration (Levaggi and Zanola, 2004;Fabrri and Rabone, 2010;Baker et al, 2014;Balia et al, 2014;Lunt and Mannion, 2014;Brekke et al, 2015) although major challenges remain, such as to delimitate the international state-of-theart concerning patient mobility across European member states (Frischhut and Levaggi, 2015). For example, evidence about patient mobility phenomenon exists within the National Health Service in the United Kingdom (Exworthy and Peckham, 2006) and also in the Italian decentralized health service (Brenna and Spandonaro, 2015). Recent evidence as also showed in Finkelstein, Gentzkow and Williams (2016) that studied the drivers of geographic variation in U.S., using an empirical strategy that exploits migration of Medicare patients to separate the role of demand and supply factors.…”