A primary care choice reform launched in Sweden in 2010 led to a rapid growth of private providers. Critics feared that the reform would lead to an increased tendency among new, profit-driven, providers, to select patients with lower health risks. Even if open risk selection is prohibited, providers can select patients in more subtle ways, such as establishing their practices in areas with higher health status. This paper investigates to what extent strategies were employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments in this regard. Three main strategies were used: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Additionally, left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time. The findings of the paper contribute to our understanding of how social inequalities may be avoided in tax-based health care systems when market-like steering models such as patient choice are introduced.

Patient choice in the context of National Health Service (NHS) reforms in England can refer to the law and policy underpinning patient movement between the NHS and private healthcare sector (in existence since the introduction of the NHS in 1948), as well as recent competition reforms of the Health and Social Care Act 2012, the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the 2014 Private Healthcare Market Investigation by the Competition and Markets Authority (CMA). This paper highlights the existence of two discrete, yet related frameworks: the ‘NHS patient – private patient’ framework based on Department of Health, NHS England and latterly Clinical Commissioning Group policy, and the ‘NHS patient choice’ framework, derived from New Labour choice and competition policies and subsequently enshrined by the 2012 Act reforms. The juxtaposition of these frameworks underscores the symbiotic relationship between the NHS and private healthcare, which raises questions about the fitness for purpose of current policy. It also helps explain why the competition reforms are difficult to implement, and suggests that the knitting together of patient choice and competition may unravel following the 2012 Act reforms and CMA private healthcare market development.

Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals’ demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals’ personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.

Objectives: To explore users' views on increased availability of emergency contraception (EC) from two new providers of EC. Context: EC was previously available from general practitioners (GPs), Family Planning Centres, Accident and Emergency Departments and Brooke Advisory Centres. Recently, EC has also become available from pharmacies and Walk-in Centres (WiCs). Design: Qualitative study using in-depth interviews. Setting and Participants: Twenty-nine women from two (WiCs) and two pharmacies in Avon. Results: Women selected their provider on the basis of convenience and accessibility. WiC users valued the advice and personal nature of the contact with WiC nurses. Women who accessed EC from a pharmacy were amenable to answering questions to obtain EC but did not see this as a time to receive contraceptive advice. Women's attitudes to pharmacy supply of EC may be related to its associations as a place of business. Phrases such as over-the-counter may reinforce this notion, reflecting the business-like nature of the questioning and the impersonal nature of the interaction. While women considered the increased availability of EC to be generally positive, some had concerns about younger women accessing EC, particularly from a pharmacy. Conclusions: Women had a favourable view of their provider of EC, whether from a pharmacy or WiC. Concerns about pharmacy access may be related to its associations as a place of business where consumers have more power in the encounter. For some, this type of ‘easier’ access was considered inappropriate for younger users.

The codes of ethics of the National Hospice and Palliative Care Organization and the National Association of Social Workers support ethical standards of client self-determination and confidentiality. Lack of societal consensus on the parameters of a terminally ill person's right to die continues to confound at times the health care field, including hospice programs. This article explores an actual case where a hospice social worker faced an ethical dilemma related to the sanctity of life versus patient autonomy. While a more seasoned social worker might have chosen a different alternative to the dilemma, this case illustrates the importance of creating an interdisciplinary rather than multidisciplinary hospice team and the need for ongoing dialogue on how to support patient choice.