Review What benefits will choice bring to patients? Literature review and assessment of implications Marianna Fotaki, Martin Roland 1 , Alan Boyd, Ruth McDonald 1 , Rod Scheaff 2 , Liz Smith Manchester Business School, University of Manchester; 1 National Primary Care Research and Development Centre, University of Manchester; 2 Peninsula Allied Health Centre, University of Plymouth, UK Objectives: To assess the demand for, and likely impact of, increasing patient choice in health care. The study examined whether patients would like to exercise choice of hospital, primary care provider and treatment, and investigated the likely impact of policies designed to increase choice on equity of access, and on the efficiency and quality of service delivery. Method: Theory-based literature review including an analysis of the intended and unintended impact of choice-related policies in health care in the UK, European Union and USA. Selected papers focused not only on offering choice to individual patients but also evidence of the impact of choice by patients’ agents such as GPs, and on the impact of introducing choice in education and social services. Results: Choosing between hospitals or primary care providers is not currently a high priority for the public, except where local services are poor, e.g. they have long waiting times and where individual patients’ circumstances do not limit their ability to travel. When patients become ill, they are increasingly likely to wish to rely on a trusted health practitioner to choose their treatment. Better educated populations make greater use of information and are more likely to exercise choice in health care. The increase in inequality which this could produce might be reduced by specific provision of information and help, enabling less advantaged populations to make choices about health care. There was little evidence in the literature that providing greater choice will in itself improve efficiency or quality of care. Conclusion: Although patients may themselves make limited use of choices, the existence of choice may, in theory, stimulate providers to improve quality of care. Patients do, however, want to be more involved in individual decisions about their own treatment, and generally participate much less in these decisions than they would wish. Journal of Health Services Research & Policy Vol 13 No 3, 2008: 178–184 # The Royal Society of Medicine Press Ltd 2008 Introduction The British National Health Service (NHS) was orig- inally designed in 1948 to give priority to collective needs rather than individual wants. Patient choice was not on the policy agenda in the United Kingdom until the market-oriented reforms in the 1990s. 1 Even then it was not vigorously pursued 2 and was mostly con- cerned with decisions made by general practitioner (GP) fund holders contracting services from hospitals on behalf of their patients. With the concept of citizen as consumer, occupying a central position in New Labour’s approach to ‘modernizing’ public services, 3 the current re-introduction of patient choice in England differs in its ambition and the scope of intended outcomes. Offering a direct choice to users is expected to create the threat of exit causing the threat of loss of income to health care providers (known as ‘contestability’ to economists), triggering improvements in efficiency, quality and responsiveness in the NHS. The other aim is to increase equity by extending choice, regarded as a good thing in its own right, 4 beyond the affluent and articulate. 5 There are also pro- posals to expand patient choice to primary care provi- ders, treatment options and to diagnostic procedures. 6 The purpose of this literature review carried out in 2004–2005 was to assess the demand for, and likely impact of, increasing patient choice in the English NHS, including the intended and unintended conse- quences of choice-related policies. The study examined whether patients would like to exercise choice of hos- pital, primary care provider and treatment, and on the impact of introducing choice in education, social ser- vices and in informal payments. The synthesis of Marianna Fotaki PhD, Senior Lecturer, Alan Boyd MSc, Research Associate, Liz Smith PhD, Research Associate, People, Management and Organisations, Manchester Business School, Booth Street East, Manchester M15 6PB, UK; Martin Roland DM, Director, Ruth McDonald PhD, Senior Research Fellow, National Primary Care Research and Development Centre, University of Manchester, Manchester; Rod Scheaff MPhil, Professor, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK. Correspondence to: Marianna.fotaki@mbs.ac.uk 178 J Health Serv Res Policy Vol 13 No 3 July 2008 DOI: 10.1258/jhsrp.2008.007163