Introducing patient choice of hospital in National Health Systems – a comparison of the UK and Norway

Background: During 2001-2005, a number of radical legislative moves expanded patient choice in Norway. A similar reform path was followed in the UK, what provides a relatively controlled context and conjuncture. Both countries have National Health Systems (NHS), and are engaged in mutual policy learning. Those shared structural and policy attributes facilitate comparative analysis, and make further policy transfers likely. In this paper we compare the development and impact of patient choice reforms in Norway and the UK during the 1990s and 2000s. Our main focus is on the 2000s reforms. Objectives: Coherent with this, the paper has five main objectives, each addressed in a separate subsection. First, we analyze the evolution of choice reforms in both countries, and its ´goodness of fit´ within broader reform packages. Second, we study the main trends in patient mobility before and after the reforms were approved. Third, we analyze the micro-level incentives and other policy instruments aimed at making choice happen. Fourth, we examine the available evidence on the impact of pro-choice reforms, based on individual micro-data for Norway. Fifth, we discuss some policy proposals which could help advancing patient choice and improving its system impact. Conclusion: The analysis carried out in this paper has tried to cast new light on the issue of choice by formulating new analytical and policy proposals based on a comparative analysis of recent data on Norway and the UK. The comparative method helps us to isolate intervening mechanisms and analyse impact. In order to make choice happen and have the expected results, expanded capacity and incentives to increase activity are required in overloaded NHS systems such as Norway and the UK. Moreover, complementary tools would be required to make the most out of hospital choice, e.g. strengthened powers and capacity at the primary care level and new information transfer tools. The two countries differ, in the period under consideration, in choice of policy instruments. In Norway the main focus has been on (a) the nation-wide introduction of ABF, and (b) the development of complementary measures to expand capacity such as allowing patient choice also to include private and foreign hospitals in 2000-2002. In the UK more emphasis has been put on (c) developing information tools and (d) introducing GP advice. Our study shows that both countries could offer policy lessons to others within the area of patient choice