Appl Health Econ Health Policy 2004; 3 (4): 195-203 ARTICLE 1175-5652/04/0004-0195/$31.00/0  2004 Adis Data Information BV. All rights reserved. Is Patient Choice an Effective Mechanism to Reduce Waiting Times? Diane Dawson, 1 Rowena Jacobs, 1 Steve Martin 2 and Peter Smith 1 1 Centre for Health Economics, University of York, York, UK 2 Department of Economics and Related Studies, University of York, York, UK In many countries, patient choice is a routine part of the normal healthcare system. However, many choice Abstract initiatives in secondary care are part of policies aimed at reducing waiting times. This article provides evidence on the effectiveness of patient choice as a mechanism to reduce waiting times within a metropolitan area. The London Patient Choice Project was a large-scale pilot offering patients on hospital waiting lists a choice of alternative hospitals with shorter waiting times. A total of 22 500 patients were offered choice and 15 000 accepted. The acceptance rate of 66% was very high by international standards. In this article we address two questions. First, did the introduction of choice significantly reduce waiting times in London relative to the rest of the country where there was no choice? Second, how were the waiting times of London patients not offered choice affected by the choice regime? We examine the evidence on these issues for one specialty, orthopaedics. A difference-in-difference analysis is used to compare waiting times for hospitals within London before and after the introduction of choice. Although there was a small but significant reduction in waiting times in London relative to other areas where there was no patient choice, the main effect of the choice regime was to produce convergence of mean waiting times within London. Convergence was achieved by bringing down waiting times at the hospitals with high waiting times to the levels that prevailed in hospitals with low waiting times. This represented a clear improvement in equity of access, an important objective of the English National Health Service. In many countries, patient choice is a routine part of the normal is high, in practice most waiting times initiatives have appealed most to those whose alternative provider offering lower waiting healthcare system rather than being tied to specific policies aimed times is located fairly close. [7] There has been no evidence to date at reducing waiting times. There is a considerable amount of on patient choice as a mechanism to reduce waiting times within a literature on patient choice as a means of making services more limited geographical boundary where travel distances are restrict- responsive to people’s needs and what influences patient choice. [1] ed. This article provides some evidence on this within the context However, many choice initiatives in secondary care are tied into of a pilot study in the London metropolitan area with the introduc- policies aimed at achieving reductions in waiting times – offering tion of patient choice as a mechanism for reducing waiting times. patients the opportunity to be treated elsewhere if the ‘usual’ provider does not have the capacity to treat them within a designat- Two objectives at the fore of the English National Health ed timeframe. Waiting times initiatives based around choice have Service (NHS) policy agenda are to develop systems for increas- expanded primarily in Denmark, Sweden, Norway and the Nether- ing patient choice and to find mechanisms that will increase lands. [2-5] Canada is considering a programme that would facilitate effective capacity for treatment of NHS patients on waiting lists. inter-provincial movement of patients facing long local waiting The London Patient Choice Project (LPCP) was one of several times. [6] Whilst long waiting times are often cited by the general initiatives in England to introduce elements of choice and to public as an important concern and expressed willingness to travel expand capacity. [8] LPCP developed systems to enable patients