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

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  • Dixon, Anna
  • Robertson, Ruth
  • Bal, Roland

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.

Suggested Citation

  • Dixon, Anna & Robertson, Ruth & Bal, Roland, 2010. "The experience of implementing choice at point of referral: a comparison of the Netherlands and England," Health Economics, Policy and Law, Cambridge University Press, vol. 5(3), pages 295-317, July.
    • Handle: RePEc:cup:hecopl:v:5:y:2010:i:03:p:295-317_00
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    Citations

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    Cited by:

    1. Or, Zeynep & Cases, Chantal & Lisac, Melanie & Vrangbæk, Karsten & Winblad, Ulrika & Bevan, Gwyn, 2010. "Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems," Health Economics, Policy and Law, Cambridge University Press, vol. 5(3), pages 269-293, July.
    2. Izady, Navid, 2019. "An integrated approach to demand and capacity planning in outpatient clinics," European Journal of Operational Research, Elsevier, vol. 279(2), pages 645-656.
    3. Sergey Shishkin & Alexandra Burdyak & Elena Potapchik, 2013. "Patient choice in the post-Semashko health care system," HSE Working papers WP BRP 09/PA/2013, National Research University Higher School of Economics.
    4. Greenhalgh, Trisha & Stones, Rob & Swinglehurst, Deborah, 2014. "Choose and Book: A sociological analysis of ‘resistance’ to an expert system," Social Science & Medicine, Elsevier, vol. 104(C), pages 210-219.
    5. Stoopendaal, Annemiek & Bal, Roland, 2013. "Conferences, tablecloths and cupboards: How to understand the situatedness of quality improvements in long-term care," Social Science & Medicine, Elsevier, vol. 78(C), pages 78-85.
    6. Chiara Seghieri & Martina Calovi & Francesca Ferrè, 2018. "Proximity and waiting times in choice models for outpatient cardiological visits in Italy," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-10, August.
    7. Victoor, Aafke & Hansen, Johan & van den Akker-van Marle, M. Elske & van den Berg, Bernard & van den Hout, Wilbert B. & de Jong, Judith D., 2014. "Choosing your health insurance package: A method for measuring the public's preferences for changes in the national health insurance plan," Health Policy, Elsevier, vol. 117(2), pages 257-265.

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