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The UK Department of Health is implementing a new system for GP specialist referrals, which will give NHS patients a choice of the hospital to which they will be referred. As of January 1st 2006, patients are being offered a choice of around five hospitals, pre-selected by their local primary care trust (PCT). By 2008, it is planned that all patients requiring a first outpatient attendance will have the choice of any NHS hospital (or private sector hospital contracting with the NHS) in England. This report details research undertaken jointly by RAND Europe, City University and the Kings Fund to investigate which factors are likely to drive patients’ choices at the point of referral. The research team used stated preference discrete choice experiments to explore the priorities of patients, from which they estimated discrete choice models. These provide some insights not only into the types of information patients require, but also the value patients place on specific aspects of hospitals’ performance and, more generally, their characteristics. The modelling results inform policy makers of the potential benefits of different ways of structuring and informing patients’ choices.

Table of Contents

  • Chapter One


  • Chapter Two

    Discrete choice modelling method

  • Chapter Three

    Research design

  • Chapter Four

    Data collected

  • Chapter Five


  • Chapter Six

    Interpretation of model results

  • Chapter Seven

    Areas for further research

  • Appendix A

    Recruitment questionnaire

  • Appendix B

    London and Norwich patient choice workshops

  • Appendix C

    Final questionnaire

  • Appendix D

    Conclusions from the pilots of the survey

  • Appendix E

    Experimental design

  • Appendix F

    Example choice card introduction

  • Appendix G

    Detailed feedback on the discrete choice exercise

  • Appendix H

    Modelling checks on ordering effects

  • Appendix I

    The jack-knife procedure

Research conducted by

The research described in this report was prepared for the UK Department of Health and was conducted by RAND Europe.

This report is part of the RAND Corporation Technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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