Health Economics, Policy and Law


Choice policies in Northern European health systems

Karsten Vrangbaeka1 c1, Ruth Robertsona2, Ulrika Winblada3, Hester Van de Bovenkampa4 and Anna Dixona5

a1 Director of Research, AKF Danish Institute of Governmental Research and University of Copenhagen, Denmark

a2 Senior Research Associate, The Commonwealth Fund, USA

a3 Associate Professor, Department of Public Health and Caring Sciences, Uppsala University, Sweden

a4 Assistant Professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands

a5 Director of Policy, The King's Fund, London, UK


This paper compares the introduction of policies to promote or strengthen patient choice in four Northern European countries – Denmark, England, the Netherlands and Sweden. The paper examines whether there has been convergence in choice policies across Northern Europe. Following Christopher Pollitt's suggestion, the paper distinguishes between rhetorical (discursive) convergence, decision (design) convergence and implementation (operational) convergence (Pollitt, 2002). This leads to the following research question for the article: Is the introduction of policies to strengthen choice in the four countries characterised by discursive, decision and operational convergence? The paper concludes that there seems to be convergence among these four countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). It appears that the institutional context and policy concerns such as waiting times have been important in affecting the timing of the introduction of choice policies and implementation, but less so in the design of choice policies. An analysis of the impact of choice policies is beyond the scope of this paper, but it is concluded that further research should investigate how the institutional context and timing of implementation affect differences in how the choice policy works out in practice.


c1 Correspondence to: Karsten Vrangbaek, Director of Research, AKF Danish Institute of Governmental Research, Købmagergade 22, 1150 København K, Denmark. Email: