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Choice policies in Northern European health systems

Published online by Cambridge University Press:  05 January 2012

Karsten Vrangbaek ,
Ruth Robertson ,
Ulrika Winblad ,
Hester Van de Bovenkamp  and
Anna Dixon
Karsten Vrangbaek*
Affiliation:
Director of Research, AKF Danish Institute of Governmental Research and University of Copenhagen, Denmark
Ruth Robertson
Affiliation:
Senior Research Associate, The Commonwealth Fund, USA
Ulrika Winblad
Affiliation:
Associate Professor, Department of Public Health and Caring Sciences, Uppsala University, Sweden
Hester Van de Bovenkamp
Affiliation:
Assistant Professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
Anna Dixon
Affiliation:
Director of Policy, The King's Fund, London, UK
*
*Correspondence to: Karsten Vrangbaek, Director of Research, AKF Danish Institute of Governmental Research, Købmagergade 22, 1150 København K, Denmark. Email: Kvr@akf.dk
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Abstract

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.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 1 , 05 January 2012 , pp. 47 - 71
Copyright
Copyright © Cambridge University Press 2012

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