Patient choice and equity in the British National Health Service

Choice and competition have been phased into many public health systems with the aim of achieving various and potentially exclusive goals such as improving efficiency, quality and responsiveness to users' needs. Yet their use to promote equity of access as evidenced recently in the British National Health Service (the NHS) is unprecedented. Giving users the power of exit over unresponsive providers is meant to address the failures of previous policies. This paper shows that there is a potential conflict between choice and equity, in terms of both the values and the outcomes each policy is likely to produce. Using a multidisciplinary and multidimensional framework, drawn from Bourdieusian sociology, feminist theory and economics, the study highlights the implications of the simplistic and one-sided conception of individual patient choice in relation to equity. It also uses the existing evidence on the impact of market competition and choice, in the UK and elsewhere, to emphasise the importance of socio-economic and psycho-social factors, which are left out of current policy considerations

Business · Competition (biology) · Economic growth · Economic Justice · Economics · Equity (law) · Equity theory · Health care · Microeconomics · Multidisciplinary approach · Patient choice · Political science · Public economics · Public relations · Social science · Sociology · Healthcare innovation and challenges · Marketing · Primary Care and Health Outcomes

• Health social movements and the hybridisation of ‘cause regimes

  Celia Roberts, I Tyler et al.•Social movement studies•2016

  Incluir item

• Patient informed choice in the age of evidence-based medicine

  Open Access•Manuela Perrotta, Josie Hamper•Sociology of Health & Illness•2023

  Incluir item

• Questioning Neoliberal Capitalism and Economic Inequality in Business Schools

  Marianna Fotaki, Ajnesh Prasad•Academy of Management Learning &…•2015

  Incluir item

• The space of access to primary mental health care

  Open Access•Marija Kovandžić, Emma Funnell et al.•Health & Place•2012

  Incluir item

• The trade-off between choice and equity

  Open Access•Mio Fredriksson, Paula Blomqvist et al.•Journal of European Social Policy•2013

  Incluir item

• ‘So just to go through the options…’

  Open Access•Annie Irvine, Paul Drew et al.•Sociology of Health & Illness•2020

  Incluir item

• Alteridade ou austeridade

  Open Access•Schenkman, Aylene Emilia Moraes Bousquat•Ciência & Saúde Coletiva•2019

  Incluir item

• Choosing not to choose—Patients' justification of a disengaged choice of primary care provider

  Open Access•Caroline Hoffstedt, Magnus Fredriksson et al.•Social Policy and Administration•2023

  Incluir item

• Positioning the ageing subject

  Open Access•Jens Lindberg, Anna Sofia Lundgren•Policy Studies•2021

  Incluir item

• The New Public Management Theory in the British Health Care System

  Open Access•Daniel Simonet•Administration & Society•2015

  Incluir item

• Performing accountability in health research

  Open Access•Aris Komporozos-Athanasiou, Mark Thompson et al.•Human Relations•2018

  Incluir item

• Sharpening the cutting edge

  Open Access•Erica Haimes, Ken Taylor•Life Sciences Society and Policy•2017

  Incluir item

• Agency versus structure or nature versus nurture

  Open Access•Marianna Fotaki•Social Science & Medicine•2011

  Incluir item

• The social meanings of choice in living-with advanced breast cancer

  Open Access•Sophie Lewis, K Kenny et al.•Social Science & Medicine•2021

  Incluir item

• The illusion of treatment choice in abortion care

  Open Access•Katy Footman•Social Science & Medicine•2024

  Incluir item

• Healthcare choice

  Open Access•Fran M Collyer, Karen Willis et al.•Current Sociology•2015

  Incluir item

• Healthcare choice

  Open Access•Jonathan Gabe, Kirsten Harley et al.•Current Sociology•2015

  Incluir item

• Can consumer choice replace trust in the National Health Service in England? Towards developing an affective psychosocial conception of trust in health care

  Open Access•Marianna Fotaki•Sociology of Health & Illness•2014

  Incluir item

• What help can you get talking to somebody?' Explaining class differences in the use of talking treatments

  Open Access•Daniel Holman•Sociology of Health & Illness•2014

  Incluir item

• The Logic of Care

  A Mol•Logic of Care•2008

  Incluir item

• Capitalism and Freedom

  Milton Friedman•Capitalism and Freedom•2002

  Incluir item

• Sick individuals and sick populations

  Geoffrey Rose•International Journal of…•2001

  Incluir item

• Handbook of theory and research for the sociology of education

  John G Richardson•Handbook of theory and research…•1986

  Incluir item

• The science question in feminism

  Sandra G Harding•The science question in feminism•1986

  Incluir item

• Outline of a Theory of Practice

  Open Access•Pierre Bourdieu, Richard Nice•On Violence•2007

  Incluir item

• The Forms of Capital

  Pierre Bourdieu•Readings in Economic Sociology•2002

  Incluir item

• Understanding Bourdieu

  Tony Schirato, Jennifer Webb et al.•Understanding Bourdieu•2002

  Incluir item

• Feminism, Theory and the Politics of Difference

  Deborah Philips, Chris Weedon•The Modern Language Review•2001

  Incluir item

• Formations of Class and Gender

  Beverley Skeggs, Bev Skeggs et al.•Formations of class and gender•2002

  Incluir item

• Building on the best – choice, responsiveness and equity in the NHS

  Open Access•Zoë Lawrence•Health Expectations•2004

  Incluir item

• Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities

  Open Access•Dana B Mukamel, David L Weimer et al.•INQUIRY The Journal of Health…•2004

  Incluir item

• Social space, social class and Bourdieu

  Open Access•Gerry Veenstra•Health & Place•2005

  Incluir item

• Mapping the determinants of health inequalities in social space

  Open Access•Anthony C Gatrell, Jennie Popay et al.•Health & Place•2004

  Incluir item

• Primary care decision making in response to psychological complaints

  Open Access•Antonietta Di Caccavo, Nasreen Fazal-Short et al.•Journal of Community & Applied…•2000

  Incluir item

• The Influence of Attitudes Toward Male and Female Patients on Treatment Decisions in General Practice

  Open Access•Antonietta Di Caccavo, Fraser Reid•Sex Roles•1998

  Incluir item

• Sick Individuals and Sick Populations

  Geoffrey Rose•International Journal of…•1985

  Incluir item

• Cultural capital and social inequality in health

  T Abel•Journal of Epidemiology and…•2008

  Incluir item

• Feminist Morality

  Elizabeth Fox-Genovese, Elizabeth Fox‐genovese et al.•Contemporary Sociology A Journal…•1995

  Incluir item

• Relationship Between Patients' Perceptions of Disadvantage and Discrimination and Listing for Kidney Transplantation

  Ann C Klassen, Allyson G Hall et al.•American Journal of Public Health•2002

  Incluir item

• Feminist Morality

  Ann E Cudd, Virginia Held•The Philosophical Review•1995

  Incluir item

• Patient Choice in Healthcare in England and Sweden

  Open Access•Marianna Fotaki•Public Administration•2007

  Incluir item

• Symposium on Changing Modes of Governance in Public Sector Organizations

  Open Access•Mike Dent, Nicolette Van Gestel et al.•Public Administration•2007

  Incluir item

• Capitalism and Freedom

  J R Hicks, Milton Friedman•Economica•1963

  Incluir item

• The Future of the Welfare State

  Dennis J Snower•The Economic Journal•1993

  Incluir item

• Do Well-Publicized Risk-Adjusted Outcomes Reports Affect Hospital Volume

  Patrick S Romano, Hong Zhou•Medical Care•2004

  Incluir item

• Social inequalities in health

  Open Access•Michael Marmot, Carol D Ryff et al.•Social Science & Medicine•1997

  Incluir item

• The physician-patient encounter

  Open Access•Amiram Gafni, Cathy Charles et al.•Social Science & Medicine•1998

  Incluir item

• Equity of access to health care services

  Open Access•Maria Goddard, Peter Smith•Social Science & Medicine•2001

  Incluir item

• Choosing a birth attendant

  Open Access•Sandra Howell-White•Social Science & Medicine•1997

  Incluir item

• Patients' decisions for treatment of end-stage renal disease and their implications for access to transplantation

  Open Access•Elisa J Gordon•Social Science & Medicine•2001

  Incluir item

• Consequences of a decentralized healthcare governance model

  Open Access•Mio Fredriksson, Ulrika Winblad•Social Science & Medicine•2008

  Incluir item

• Equality and Choice in Public Services

  Julian Le Grand•Social research•2006

  Incluir item

• Health Lifestyle Theory and the Convergence of Agency and Structure

  Open Access•W C Cockerham•Journal of Health and Social…•2005

  Incluir item

• Theorising class, health and lifestyles

  Open Access•Simon J Williams•Sociology of Health & Illness•1995

  Incluir item

• Doing Nothing is No Choice

  Open Access•Cathy Charles, Tim Whelan et al.•Sociology of Health & Illness•1998

  Incluir item

• Beyond Modernisation? Social Care and the Transformation of Welfare Governance

  Open Access•Janet Newman, Caroline Glendinning et al.•Journal of Social Policy•2008

  Incluir item

• Welfare State Policy and Informal Long-Term Care Giving in Austria

  Open Access•Elisabeth Hammer, August Österle•Journal of Social Policy•2003

  Incluir item

• Agency, Rationality and Social Policy

  Open Access•Paul Hoggett•Journal of Social Policy•2001

  Incluir item