Is patient choice the future of health care systems?

Patient and user choice are at the forefront of the debate on the future direction of health and public services provision in many industrialized countries in Europe and elsewhere. It is used both, as a means to achieve desired policy goals in public health care systems such as greater efficiency and improved quality of care, and as a good with its own intrinsic value. However, the evidence suggests that its impact on efficiency and quality is at best a very limited while it might have negative consequences on equity because the pre-existing inequalities of income and education could influence patients' access to information and, consequently, choices. The paper attempts to introduce multidisciplinary frameworks to account for the social and cultural factors guiding patients' choices and to explain the rationale, processes and outcomes of decision making in health care.