The above-mentioned patient choice agenda in healthcare refers to various types of service providers into the NHS. Choice agenda is dynamic and varies according to time and medical providers. Choice alone without competition gives people a false consciousness without real outcome. Therefore choice and competition work well together rather than individually improving quality and efficiency. Even less competitive health-care providers are motivated to upgrade their services to attract customers.
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Extending choice agenda tends to eliminate inequalities for less affluent patients. Evidence tells us that choice agenda offers equal opportunities for all and minimise inequalities within healthcare (Dixon, 2003). In 2005 MORI carried out a study and discovered that 5o per cent of the general public prefer to select health-care providers outside their local area comparing with four per of people. Therefore, this study tells us that the general public likes the idea to select for alterative health-care providers.
However amplifying patient choice may “not successfully eliminated inequities” (Stevens, ). Offering choice to the general public is less likely to improve equity if mythological varieties exist within the uptake of choice. Wealthy patients have the freedom pick for private health -care providers if they believe local health-care providers offer poor quality of services, less likely to specialise in their condition and have low rating. Therefore the idea of equal access for meeting equal need to all people failed. 
On the whole, the British Social Attitudes Survey outlines that disadvantaged groups, linked to education, income social class, tend to opt for alternative health-care providers far higher than affluent patients. For instance people with an income of £10,000, females, working class and low level of educational attainments tend to make use of choice agenda far more than well-off people. A similar study was carried out in Helsinki, Finland and found related results empathising working class people like the idea to choose health -care providers to a greater extent than middle class. Therefore, these examples emphasise no differentiation in the uptake of choice between various socioeconomic classes.
2New Labour accepted the neoliberal model developed by Thatcher’s administration during 1990s. In 1997 under New Labour patient choice increased and here are some important reforms promoting patient choice agenda: Foundation Trusts (FTs) and rating system. These reforms tend to promote cheap and quality services. This is likely to motivate health-care providers contesting for funding which correlates with the capacity of patients treated. On the other hand Payment by Results which pay secondary care providers using a standard for tariff liked with the amount of patients treated. This reform promotes patient choice upon referral from GPs. Therefore this notion of choice agenda tends to improve waiting list times and quality of services. Last but not least the government tend to places a target system that measures the uptake of choice. The government shifted the attention from competition and continued to promote the business model by promoting partnerships between health-care providers.
In order for promote real choice; the market is obliged to provide alternative providers. Private providers have a long legacy operating within the internal market since 1948 as long as they provide services at a standard tariff. The internal operating under New Labour is less focused solely on competition, but is rather promoting efficiency and quality of services. Evidence shows that patients opt for private health-care providers over public health-care providers because providers exhibit good service quality. In general, patient choice tends to enhance competition among providers to attract customers.
On the contrary private health-care providers tend to cover limited services such as non-emergency ones. Patients may demand more services rather than less at higher costs which tend to put pressure on providers to deliver services at high standards. Often private medical providers are likely to display egocentric focused on profit making. In general private providers tend to cost more than services offered by the NHS. Hence this market tends to favour wealthy and competitive patients rather than less well-off.
In 2010 White Paper, Equity and Excellence: Liberating the NHS, the Coalition government tends to promote patient choice by introducing a Commissioning Board in the NHS. The Board monitors the performance of primary care providers to ensure health-care providers offer high standard of service care and involve patients in decision making. In addition the commissioning board is also made responsible for tacking equity within healthcare. Also, the government is aiming to increase competition and turn secondary care providers into Foundation Trusts becoming a financial regulator focused on tariff princes and competition as well as promote efficiency. Finally the Foundation Trusts tend to become social enterpriser which is likely to involve medical professionals in decision-making.
Choice’ isn’t real for patients living in certain areas of the UK. People living in rural areas of London tend to be excluded from selecting health -care providers. Less affluent patients are less motivated to travel long distances because car ownership is low among disadvantaged groups. Also some people in low paid employment are unable to take time off from work preventing them further from exercising choice. In general, people travelling long distances tend to have poor attendance records for primary care appointments. A study conducted by () show that age, gender and social class differences prevents people from exercising choice. People over 60 year olds, housewives and working class tend to limit travelling distances to search for providers (both primary and secondary care). Hence gender, social class and age tend to be factors that determine the uptake of choice for health-care providers.
Affluent patients tend have resources to purchase houses in areas near good -quality health -care providers. An example discovered by () argues that young, affluent patients and living in inner city areas of London are likely to opt for alternative medical health-care providers.  Whereas disadvantaged groups with low levels of education are found to least opt for alternative medical providers. The uptake of choice agenda among poor individuals is likely to improve when subsidised transport is offered to people, providing additional transport costs and better public transport on the outskirts of the UK. Hence improving the above issues tends to encourage poor patients to travel long distances to have their treatments.
Also, lack of available information tends to prevent patients from exercising choice for medical providers. It is believed that some people need additional support to choice medical health-care providers. Often, less well-off patients, low levels of education and the elderly require supplementary assistance to make effective choices. These types of groups are less likely to have access to internet connections, sources or/ and social networks that work in hospitals often equipping them with information of various health-care which tends to help them navigate the system. This source has been criticised for being resource intense and a real problem for those who are not computer literature.
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Published data is a key element for choice that emphasis the performance of various health-care providers. Making use of this type of data tends to make patients autonomous and self-responsible for their own health. In general, health- care providers use ranking systems to upgrade their services. With their reputation at stake, medical providers are motivated to improve quality of services in order to remain in business. Often, disadvantaged groups use performance data more than middle class people to make health care choices. But lack of available data is a major factor perverting them from exercising choices.
Patient choice agenda tends to lead to equity. Reid () claims methodological variations in healthcare are far more complex rather than focusing solely on resources. Poor people tend to lack self-confidence and knowledge to converse with health-care providers in medicinal vocabulary. Evidence shows patient’s poor ability of expression creates imperfect freedom of choice in decision-making amongst individuals. In general, these issues lead to “unequal ability to navigate the system”.
Although providing people with choice rather than a voice tends to be more effective for less well-off patients. Patient choice agenda gives disadvantaged groups the opportunity to be heard and necessary self- confidence to exercise choices. Therefore, choice empowers patients that are least knowledgeable how to manoeuvre the system. Middle class people, on the other hand, have power, resources and skills to manipulate the system in a particular way that suites their interests. Certainly affluent patients are more proactive than less -well of patients in comparison to choice agenda. Hence privileged patients are more articulate, confident and persistent which often this system suites privileged patients rather than poor people.
The impact of patient choice on health services delivery tends to provide mix views. Patient choice may improve the quality of services under the internal market in response to waiting list times. GP fund holders improve waiting list times upon referral to hospitals and reduce cost for prescriptions. An example that may fit in this capacity is found in a study conducted by London Patient Choice Project. This study states that patients tend to look for alternative medical providers in order to reduce waiting list times. Certainly competition together with high numbers of health care providers may further reduce waiting list times.
However dissatisfied patients with services offered by medical providers tend to opt for the option to search for alternative medical providers that meet their needs. Under the internal market, money dictates the choices patients make, meaning that hospitals lose money patients choose alternative medical providers. Thus health-care providers must responsive to consumer demands in order to remain in business, unless they are likely to face closure.
Patients tend to empower medical experts to decide treatments because the “doctor knows best”. Often, patients shift choice into the hands of doctors, particularly in life-threatening situations. In life threatening situations medical staff is likely to decide treatments on behalf of patients. Therefore, the choice agenda in this case regarding to the quality of treatment tends to have no result. Evidence suggests that seven out of ten patients like better to relocate treatment choices to primary care providers (). This example tells us that people like the idea to have an input in relation to deciding medical providers.
In reality, GPs are seen as the “gatekeepers” for making choices. They act as agents for patients rather than patients exercise choice. Often, patients empower medical providers to select treatments. This happens because people tend to have limited skills and access to information that would inform people of various treatments. Middle class people are often informed of the premium treatments. These people have access to internet and sources like books and journals that inform them of various treatments. People with lower levels of education tend to have access to journals and books which allow them to make meaningful choices. London Patient Choice Pilot study, on the other hand, contradicts this view. This study claims the up-take of choice among people with various levels of education has little significance. Only two per cent difference between people with various levels of education tend to look for hospitals that provide treatment.
In conclusion middle class people tend to benefit from choice agenda far more than working class groups. Middle class groups have higher income which allows them to purchase houses near good-quality medical providers. In addition middle classes have access to information and money that drive them to travel further in order to have access to the best services. Do patients what choice? Patients tend to like the idea of a good local medical provider (both primary and secondary providers) rather than travelling longer distances to have their treatment.
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