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Does patient choice improve healthcare?

Consumer choice, one of the two major bedrocks of modern free-market capitalism (the other being free enterprise), is considered essential in most sectors of the economy: without it there is little incentive for suppliers to make improvements and compete with each other in either quality or cost effectiveness and no scope for consumers to select products and services that best suit their own specific desires and needs. 

Indeed in most areas of the economy consumer choice is so ubiquitous that we mostly take it for granted, and sometimes even complain about having too much of it (as is best exemplified by American psychologist Barry Schwartz’s book ‘The Paradox of Choice: Why Less Is More’). Very rarely do people consider what living in a world without it would be like – imagine what going out for dinner in the Soviet Union would have been like.

But giving patients choice in where or who they receive their healthcare from is not so ubiquitous. In part this is due to most countries having extensive public health systems. But some countries, including the UK, have experimented with introducing patient choice into the public health sector, to varying degrees. 

The European country which has introduced the most extensive patient choice reforms is Sweden, where patients have the right to attend any GP practice (public or private) anywhere in the country and pay the same fee. This feature, combined with an annual survey that ranks all the GP practices on patient satisfaction (the National Patient Survey) introduces a significant competitive element to Swedish primary care.

But has it improved outcomes? A 2020 academic article found that whilst the patient choice reforms did lead to increased entry by private providers and increased competition within the sector, this led to only a modest improvement in patient satisfaction – and no significant overall impact on objective outcome measures such as avoidable hospital rates.

When patient choice has been introduced in the NHS in the UK, patients haven’t made much use of it. In general, NHS patients prefer to have decisions about where they receive treatment from made for them by health professionals. And a report by the Centre for Health and Public Interest concluded that ‘the research on implementing patient choice in health care suggests that its impact on efficiency and quality is at best very limited, while it may have negative consequences for equity.’

This shouldn’t be all that surprising. It has long been recognised by health economists that patients are generally not good at judging the quality of the healthcare services they receive. And if they cannot make such judgements, there is no reason to expect that increasing patient choice will improve quality of care. However, there is some potential for patient choice being able – at least in theory – to improve efficiency: one thing patients are very good judges of is waiting times!

 

We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.