Do patients really want ‘choice’?
 The government’s choice agenda risks increasing inequalities because some groups of patients are more heavily influenced by clinical performance than others, according to a Department of Health commissioned report.
The study from the King’s Fund, Understanding Patients’ Choices at the Point of Referral, found that patients with educational qualifications were more likely to choose hospitals with higher standards of clinical performance. Less well educated people placed significantly less importance on increases in clinical quality above an ‘average’ level.
The report says: “This could widen inequalities of access to high performing hospitals and the ‘market’ signals sent to providers by patients’ choices would be inconsistent.”
The King’s Fund report, co-authored with City University and policy research organisation RAND Europe, was based on the results of a survey of 1000 people in England who have experience of being referred to a hospital for elective treatment in the past five years.
Patients were offered a series of hypothetical choice scenarios and the report examined both the choices made and the trade-offs between the choices.
The report found that although GPs’ advice over which hospital to choose was found to be important, it did not override other information such as information about the performance of hospitals and travelling time. Negative advice from the GP was given a higher weight than positive advice in favour of a particular provider.
The study also found that reductions in waiting times below 10 weeks were not valued by respondents and exerted no influence over the choice of hospital.
Peter Burge, senior analyst at RAND Europe, said: “Many patients want and value more choice in health services, but this study exposes real differences in the choices that patients with different levels of education are likely to make. It raises uncomfortable questions about how best to provide a health service that promotes equal access to the best performing hospitals for those in equal need.”
The report suggests that further research could be carried out including a collection of data on revealed preference through Choose and Book.
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