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Health care providers in the United States recognize the role of patient satisfaction in building customer loyalty, but this is a new concept in the United Kingdom because, until very recently, choice has been extremely limited.
Recent reforms to the British health system in 1990 were aimed at increasing consumer choice by encouraging providers to compete for patients. But, unlike their American counterparts, U.K. consumers have not yet acquired the necessary skills to make informed health care choices and are unfamiliar with the concept of competitive health services. Only by experiencing and evaluating what is currently being offered can consumers form a basis upon which to make future choices in this market.
Compounding the problem is the fact that health care providers in the United Kingdom are not permitted to advertise their services or overtly recruit patients, which limits the information available to consumers to help them make an informed decision.
The British Health Service has two characteristics that distinguish it from the American system: It is funded through central taxation and is free at the point of delivery. Funding, administration, and the location of units are managed centrally, and all U.K. residents theoretically receive the same health care provision. Within the National Health Service (NHS), access to hospital services is strictly controlled by the primary care doctors (GPs). Most GPs operate in group practices, where they provide a range of health care services from a community-based center.
Prior to 1990, patients had no real choice of primary health care provider because the location and density of GPs in any area was regulated. This led to unofficial boundaries between practices, and changing of practice, other than through relocation, was discouraged. The culture of primary care was one in which there was no expectation of choice and no conscious decisions to make about the health care provider.
EVALUATING QUALITY
The purpose of the reforms was to promote competition between practices by removing barriers to changing practice registration and providing incentives for practices to actively attract more patients. These reforms are based on an implicit assumption that this market operates like any other and that practices providing better quality services will be able to attract more patients. However, policy makers have paid little attention to the...