Edited by Alistair McGuire and Joan Costa-Font
Chapter 5: Choice in Health Care: Drivers and Consequences
Valentina Zigante, Joan Costa-Font and Zack Cooper 1. INTRODUCTION Choice and competition policies, and particularly the expansion of user choice, are increasingly promoted instruments in public health care systems. The policies are viewed as the modern answer to the tension that is inherent to health care: how to ensure equity while maintaining efficiency, and at the same time constrain costs (Bevan et al., 2010). Choice and competition, in quasi-market or managed competition structures of health care provision, are argued to constrain costs, improve equity in the provision of health care, but also to improve the responsiveness of health care systems (Le Grand, 2007). These visualised improvements respond to the contemporary challenges of health care systems: cost containment; inequalities in the access to health care; and a perception that health care systems are unresponsive to patients (Schoen et al., 2005). These developments in the health care sector further correspond to a more general lack of public participation in decision making, particularly in regard to public services, where consumerism has become a common answer. The motivations found in the literature for increasing user choice and competition in the health care sector can be attributed to two broad categories, which we in this chapter discuss in terms of extrinsic values and intrinsic values of choice (following Dowding and John, 2009). The intrinsic value of choice, in and of itself, is in essence the value attributed to the act of choosing. This would imply that choice is valued above and beyond instrumental welfare gains...
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