User choice in European health systems: towards a systematic framework for analysis

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.