The experience of implementing choice at point of referral: a comparison of the Netherlands and England
Abstract
The implementation of choice for patients over where and when they are seen by specialists in hospital outpatient clinics has been supported by electronic referral systems in England and the Netherlands. This paper compares the implementation of 'Choose and Book' in England and 'ZorgDomein' in a region of the Netherlands. For England the analysis draws on national data and published studies on 'Choose and Book', national patient surveys, and qualitative data based on general practitioner (GP) focus groups. For the Netherlands the analysis draws on qualitative data collected during observational study as well as survey data among patients, GPs and medical specialists. We find that despite significant differences in the genesis and design of the policy, similar challenges have been faced. The electronic referral systems have forced changes to the process of care at the interface between primary and secondary care and standardisation between practices. Although these changes have the potential to generate improvements and benefits, for example, convenience, certainty and choice for patients and efficiency gains through for example reduced do not attend rates, repeat consultations and duplicative diagnostic tests; they have also generated problems during implementation including GP resistance. Policy ambitions for patient choice may not be realised if the implementation of the booking system is not carefully designed and evaluated.
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It was anticipated that by replacing the traditional paper system with an integrated electronic system, Choose and Book would be more convenient for patients and GPs, reduce referral-based enquiries, and lessen the bureaucracy associated with referrals.
“It was also anticipated that by replacing the traditional paper system (in which referral letters were typed, printed and then either faxed, posted or collected on a daily courier round) with an 'integrated' electronic system, Choose and Book would also (a) be more convenient for patients and GPs; (b) reduce the number of referral-based enquiries GPs and their staff had to deal with; (c) lessen”
All the anticipated benefits of Choose and Book were expected to increase the speed and efficiency of referrals and help achieve the target of the '18-week wait' for first outpatient appointment.
“All this, it was anticipated, would increase the speed and efficiency of referrals, and help achieve the target of the '18-week wait' for first outpatient appointment.”
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- Authors
- Dixon, A., Robertson, R., & Bal, R.
- Affiliations
- King's Fund (GB)
- Erasmus University Rotterdam (NL)
- Corresponding author
- Dixon, Anna
- ORCID
- Bal, Roland
- Venue
- Health Economics Policy and Law
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-07
- Volume
- 5
- Issue
- 3
- Pages
- 295-317
- ISSN
- 1744-1331 (ISSN-L)
- 1744-134X
- OpenAlex
- W2168416305
- Cited by
- 86
- References
- 24
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2021: 3 · 2020: 5 · 2019: 13 · 2018: 5 · 2017: 3 · 2016: 8 · 2015: 6 · 2014: 9 · 2013: 7 · 2012: 7
- FWCI
- 15.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Economics Policy and Law (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- patient choice, electronic referral system, hospital outpatient clinics, primary-secondary care interface, implementation barriers, comparative health policy, England, Netherlands
- MeSH terms
- Choice Behavior, England, Health Services Accessibility, Health Services Needs and Demand, Humans, Medicine, Netherlands, Referral and Consultation, Patient Satisfaction, Focus Groups, Health Care Reform, Health Care Surveys, Qualitative Research, General Practitioners
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