Quality decreases from introducing patient choice in a National Health Service

A view often expressed about patient choice of health care providers is that it will increase competition between providers, which benefits the efficiency system. We address here a initiative, regarding selection hospital for specialty consultations, in Portuguese National Health Service (NHS) has two specific features. The first feature involves shared decision making patients and GPs, referral, should be based on publicly available information “quality”. second initiative did not involve payment changes to NHS hospitals associated with patients’ movements. show explaining initial asymmetries qualities (waiting times) systematic differences characteristics (cost advantages managerial talent) leads potential asymmetric responses introduction NHS. This implies empirical analysis accommodate such asymmetries. Explicitly allowing policy measure reveals reactions were indeed different, top-performance reducing their (increasing waiting after was introduced.