What market-based patient choice can’t do for the NHS: The theory and evidence of how choice works in health care

Prof Marianna Fotaki | March 26, 2014 | Analyses


This analysis looks at how the concept of patient choice has worked in the NHS in recent years. It finds that the type of patient choice that contemporary health policy draws on almost exclusively is based on a flawed account of what choices actually mean for patients. Such conception of choice rests on the simplistic and erroneous assumption that appealing to patients’ self-interest will make them behave as consumers in a market place. For choice to work, policy design needs to recognise patients’ multiple needs and their bonds as community members, addressing them as socially embedded individuals. Users’ prior experiences, including their experience of health services, and how the reality of being ill might affect their health-related decisions, need to be accounted for.

What market-based patient choice can’t do for the NHS: The theory and evidence of how choice works in health care

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About the author

Prof Marianna Fotaki

Prof Marianna Fotaki

Marianna Fotaki is Full Professor of Business Ethics at University of Warwick Business School working on the marketization of health policy, inequalities in organizations and society, solidarity responses to refugee and forced migrants arrivals as well as whistleblowing. With Professor Kenny and Dr Wim Vandekerckhove, she has published The Whistleblowing Guide: Speak‐up Arrangements, Challenges, and Best‐Practices, Wiley (2019).See all posts by Prof Marianna Fotaki