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Patient choice: how patients choose and how providers respond


The policy of offering patients a choice in where they receive hospital treatment was intended to create competition between providers, encouraging efficiency and responsiveness to patients' preferences and ultimately to drive up the quality of care. So has the policy met those aims?

Since January 2006, patients requiring a referral to a specialist have been entitled to a choice of four or five providers. And from April 2008 that choice has been extended to any eligible NHS or independent sector provider in England – so-called 'free choice'.

Key questions

Patient choice: how patients choose and how providers respond considers how choice of provider is operating in practice and its impact on hospital providers. More specifically, the report aims to answer the following questions.

  • How do patients experience choice?

  • What factors are important to patients when choosing between providers?

  • How do GPs support choice?

  • How are providers responding to choice?

About the study

The study was conducted in four areas in England and included questionnaires sent to patients and interviews with patients, GPs and providers. The results showed that choice was important to the majority of patients but just under half recalled being offered a choice. There were differences in patient, and GP and provider views on who thought choice was important, who was offered a choice and who chose to travel beyond their local hospital for treatment.

Data from choices made in hypothetical and real situations showed that patients valued aspects of quality when choosing a hospital. However in practice, most patients chose to be treated by their local provider and few consulted published performance information on quality to help them choose, instead relying on past experience and their GP's advice.

While the threat of patients choosing a different hospital led some providers to focus more on reputation, there was little evidence of direct competition for patients' custom and choice has not so far acted as a lever to improve quality.

The information about how patient choice is working in practice will be invaluable to those seeking to implement the policy at national and local level.