aLSE Health and Social Care, London School of Economics and Political Science, London, UK.
Health Econ Policy Law. 2010 Jan;5(Pt 1):13-30. doi: 10.1017/S1744133109990132.
This article proposes a systematic framework for analysis of the increasingly popular concept of user choice in European health systems. The development of such a framework is exemplified using one category of potential choice: the choice of health service provider. In the first part, the paper summarises the conceptual background of the user choice debate. Subsequently, the paper theoretically analyses the concept of user choice alongside a stringent set of standard dimensions embracing technical, administrative and allocative efficiency, as well as equity in access and finance. Reference to available evidence is made where applicable. The employed dimensions are critically discussed and finally mapped against the identified determinants within a systematic matrix framework for analysis. Furthermore, the paper underlines that user choice is by no means a panacea but rather a highly complex and ambiguous political strategy. Extended choice in some sectors and levels of health systems may lead to inefficiencies and may therefore lead to loss of benefits, including choice, for individuals and society.
本文提出了一个系统的框架，用于分析在欧洲卫生系统中日益流行的用户选择概念。该框架的发展以一个潜在选择类别为例：卫生服务提供者的选择。在第一部分中，本文总结了用户选择辩论的概念背景。随后，本文从理论上分析了用户选择的概念，并围绕着一套严格的标准维度，包括技术、行政和分配效率，以及获取和融资方面的公平性。在适用的情况下，还参考了现有证据。所采用的维度受到了批判性的讨论，并最终在一个系统的矩阵框架内与确定的决定因素相对应。此外，本文强调用户选择绝不是万灵药，而是一个高度复杂和模糊的政治策略。在卫生系统的某些部门和层面扩大选择可能会导致效率低下，并因此可能导致个人和社会失去利益，包括选择。
