Health Care 2.0: NHS offers choice and asks for your opinion

Choice is a foreign concept in most health care systems around the world. Sick patients are advised on the appropriate course of treatment by their doctor, referred to a specialist where appropriate and then handed a appointment time — choice rarely enters into the process. Broadly speaking, the assumption is that patients are not sufficiently informed to make reasonable choices about their health care, so there is little point even offering choice. In fact, choice could lead to confusion and poor choices could give rise to unintended consequences and even fatalities.

As Paul Hodgkin, a Sheffield-based GP in the UK observes in his blog on patientopinion.org.uk “All health care systems are bedeviled by the problem that sick ill people make poor shoppers. Patients are consistently disadvantaged by having less knowledge, less power and more vulnerability than other players in the health care system.” These asymmetries of information and power, says Hodgkin, are the reason why markets are such a poor way to deliver health care.

Hodgkin rightly points out that some of these asymmetries have been lessened by the explosion of health care information on the Web. It’s increasingly common for patients to walk into their doctor’s office clutching an armful of printouts from the Web. And doctors sometimes candidly admit the need to frequently refresh their knowledge of particular illnesses, simply to keep up with their patients!

Increasingly confident health care consumers are now demanding increased choice in health care services. A 2005 British Social Attitudes survey revealed that 65% of patients said they wanted choice of treatment, 63% wanted a choice of hospital and 53% welcomed a choice of appointment time. I’m frankly amazed that the percentages were not significantly higher.

Seeing the writing on the wall, the NHS responded with what it describes as a “dramatic expansion in patient choice.” The introduction of free choice means, among other things, that patients referred to see a specialist are themselves able to choose where they are treated from any hospital that meets NHS standards. Patient choice, in turn, introduces an element of competition that should encourage poor facilities to improve as patients seek out practitioners in the best hospitals.

Now, to help inform people’s choices about which treatments options to pursue and which hospitals to visit (this is where Wikinomics comes in), the NHS has set up a peer rating site called NHS Choices where patients can rate different hospitals and provide feedback on their experiences. Subsequent visitors benefit from the wealth of patient knowledge as it accumulates and the NHS gains the ability easily compare ratings across NHS facilities and thus pinpoint weaknesses in the system.

Such ratings sites have long existed, of course. RateMDs.com is one of the most notable examples. The site allows users to rate their general practitioners so that the broader community can make informed choices when selecting a doctor. To the best of my knowledge, NHS Choices is the first time that a major government health authority has actually endorsed and hosted a user-generated site of this nature, which brings us back to Patient Opinion and Paul Hodgkin.

Patient Opinion has hosted an independent but analogous rating and feedback service for several years with considerable success. So why reinvent the wheel? Indeed, when NHS Choices launched in April this year, Patient Opinion promptly took the feed from the comments site and mashed it with its own service. Visitors to Patient Opinion can now see comments about hospital care from both sites simultaneously.

All of this raises questions about whether governments ought to be building web sites at all? Couldn’t the NHS simply have exposed the underlying data and allowed third parties like Patient Opinion to enhance the services that it already offers to the public?

Paul Hodgkin certainly thinks so. Echoing a view that we have frequently espoused on this blog (see here and here, for example) Hodgkin points out that “the first priority of government should be to make its data available on net in ways which are open, standards-compliant, and re-usable by third parties – whether they be commercial or third sector organisations – because others will innovate around the data far faster and more freely than government ever can.”

Given that the UK Department of Health intends to spend £60-80m over three years to develop the NHS Choices web site, these questions are well-worth asking. It could well be the case that the additional services that the NHS could integrate into it’s Choices platform (e.g., the ability to schedule a visit with a specialist online) could justify the investment. I’d like to hear your opinion.