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Can patient choice shape organisational behaviour to provide patients with what they want?
  1. Tom Smith
  1. Senior Policy Analyst, Health Policy and Economic Research Unit, BMA House, Tavistock Square, London WC1H 9JR, UK

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    Choice mechanisms enhance equity by exerting pressure on low quality or incompetent providers” Tony Blair, 23 January 2003

    Recently published papers illuminate some tensions between differing conceptions of what the extension of patient choice will mean for the UK National Health Service (NHS). While some promote a consumerist model, others favour a more personally engaging interpretation. This contrast is evident in two consultation documents on choice issued by the government. The first (Payment by results consultation: preparing for 2005, available at is concerned with financial flows and the setting up of a system by which money follows the patient, and the second (Fair for all, personal to you: a consultation on choice, responsiveness and equity, available at more with patient experience, asking questions about the choices patients want and the information they need to exercise them. The following papers are written across the spectrum of choice and offer insight for the NHS in shaping choice in practice.

    A Push to give the public choice of provider in the UK public sector ▸

    In 2001, Prime Minister Tony Blair said choice “should be a central principle for reform”. From 2005 it will come to the NHS in the form of patients being offered a choice of secondary provider for some elective treatments. In this context “choice” means “a set of institutionalised arrangements that provide opportunities to make decisions expressing preferences between a defined menu of options”. The term is exclusively individual. This form of choice has been introduced in other sectors—a nursery school voucher scheme introduced in 1996 (but abandoned the following year) and choice of secondary school introduced in 1988. A paper in the Journal of Social Policy examines the goals, experience, and unanticipated side effects of choice within each.

    It is difficult to establish whether initiatives have been successful because “there are few objective, comprehensive, detailed and rigorous …

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