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.

Additional Metadata
Keywords Netherlands, United Kingdom, article, comparative study, health care delivery, health care planning, health care policy, health care system, medical decision making, medical practice, online monitoring, organizational efficiency, organizational structure, patient decision making, patient information, patient referral, primary medical care, priority journal, public health service, qualitative analysis, quantitative analysis, standardization
Persistent URL dx.doi.org/10.1017/S1744133110000058, hdl.handle.net/1765/21128
Citation
Dixon, A.L., Robertson, R., & Bal, R.A.. (2010). The experience of implementing choice at point of referral: A comparison of the Netherlands and England. Health Economics, Policy and Law, 5(3), 295–317. doi:10.1017/S1744133110000058