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The experience of implementing choice at point of referral: a comparison of the Netherlands and England

Published online by Cambridge University Press:  01 July 2010

Anna Dixon ,
Ruth Robertson  and
Roland Bal
Anna Dixon*
Affiliation:
Director of Policy, The King’s Fund, London, UK
Ruth Robertson
Affiliation:
Senior Researcher, The King’s Fund, London, UK
Roland Bal
Affiliation:
Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
*
Correspondence to: Anna Dixon, Director of Policy, The King’s Fund, 11-13 Cavendish Square, London W1G 0AN, UK. Email: a.dixon@kingsfund.org.uk
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Abstract

The implementation of choice for patients over where and when they are seen by specialists in hospital outpatient clinics has been supported by electronic referral systems in England and the Netherlands. This paper compares the implementation of ‘Choose and Book’ in England and ‘ZorgDomein’ in a region of the Netherlands. For England the analysis draws on national data and published studies on ‘Choose and Book’, national patient surveys, and qualitative data based on general practitioner (GP) focus groups. For the Netherlands the analysis draws on qualitative data collected during observational study as well as survey data among patients, GPs and medical specialists. We find that despite significant differences in the genesis and design of the policy, similar challenges have been faced. The electronic referral systems have forced changes to the process of care at the interface between primary and secondary care and standardisation between practices. Although these changes have the potential to generate improvements and benefits, for example, convenience, certainty and choice for patients and efficiency gains through for example reduced do not attend rates, repeat consultations and duplicative diagnostic tests; they have also generated problems during implementation including GP resistance. Policy ambitions for patient choice may not be realised if the implementation of the booking system is not carefully designed and evaluated.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 3: Special Issue on Cross-Country Issues in Health Care: Choice, Equity, Efficiency and Cost , July 2010 , pp. 295 - 317
Copyright
Copyright © Cambridge University Press 2010

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