Abstract
BackgroundToday, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. However, patients often visit the provider that is recommended by their general practitioner (GP). The introduction of patient choice requires GPs to support patients to be involved, actively, in the choice of a healthcare provider. We aim to investigate whether policy on patient choice is reflected in practice, i.e. what the role of the patient is in their choices of healthcare providers at the point of referral and to what extent GPs’ and patients’ healthcare paths influence the role that patients play in the referral decision.MethodsIn 2007–2008, we videotaped Dutch GP-patient consultations. For this study, we selected, at random, 72 videotaped consultations between 72 patients and 39 GPs in which the patient was referred to a healthcare provider. These were analysed using an observation protocol developed by the researchers.ResultsThe majority of the patients had little or no input into the choice of a healthcare provider at the point of referral by their GP. Their GPs did not support them in actively choosing a provider and the patients often agreed with the provider that the GP proposed. Patients who were referred for diagnostic purposes seem to have had even less input into their choice of a provider than patients who were referred for treatment.ConclusionsWe found that the GP chooses a healthcare provider on behalf of the patient in most consultations, even though policy on patient choice expects from patients that they choose, actively, a provider. On the one hand, this could indicate that the policy needs adjustments. On the other hand, adjustments may be needed to practice. For instance, GPs could help patients to make an active choice of provider. However, certain patients prefer to let their GP decide as their agent. Even then, GPs need to know patients’ preferences, because in a principal-agent relationship, it is necessary that the agent is fully informed about the principal’s preferences.
Highlights
Today, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider
In practice, instead of making active choices, patients tend to visit the default provider, often the one that is recommended by their general practitioner (GP) [7,8,9,10]
Research focus We aim to investigate if policy regarding patient choice is reflected in practice at the point of referral, i.e. whether GPs help patients to make an active choice of a healthcare provider, for example by informing them about different referral options, giving them information about alternatives and asking for their preferences
Summary
In several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. Patient choice of healthcare providers is currently an important element of the healthcare systems of various north-western European countries and is often supported by law. Choice was introduced as one element of regulated competition [1,2,3] Within this context, patients are viewed as autonomous healthcare consumers [3] and are expected to make active choices or, put differently, deliberate choices between healthcare providers. Patients are viewed as autonomous healthcare consumers [3] and are expected to make active choices or, put differently, deliberate choices between healthcare providers These choices would, in theory, be based on comparing information on quality and price [4]. In practice, instead of making active choices, patients tend to visit the default provider, often the one that is recommended by their general practitioner (GP) [7,8,9,10]
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