title: Opportunities and limitations of patient choice: the case of the Russian Federation.
abstract: While many countries have increased the opportunities for patient choice of provider, there is debate to what extent this has had positive effects on efficiency and quality of healthcare provision. First, some conditions should be met to exercise such choice, of which the most important is the provision of reliable data on providers' performance to both patients and physicians as their agents, as well as increasing primary health care (PHC) providers' involvement in realization of patient choice. Second, expanding patient choice does not always lead to efficient allocation of resources in a healthcare system. This article explores these controversial developments by using empirical evidence from the Russian Federation. It shows that choice indeed has value for patients, but there are many areas of inefficient choice, which leads to misallocation of healthcare recourses. Thus, health policy in this area should be designed to ensure a reasonable balance between objectives of expanding choice and promoting more efficient organization of healthcare provision. Political rhetoric about unlimited patient choice may be useless and even risky unless supported by well-balanced programmes of supporting and managing choice.
authors.affiliation: National Research University-Higher School of Economics, 20 Myasnitskaya Street, Moscow 101000, Russia. E-mail: igor.sheiman@g23.relcom.ru.
authors.forename: Igor
authors.initials: I
authors.lastname: Sheiman
authors.forename: Sergey
authors.initials: S
authors.lastname: Shishkin
authors.forename: Helen
authors.initials: H
authors.lastname: Markelova
mesh_terms: D016536:Competitive Medical Plans / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D005382:Financing, Personal; D006291:Health Policy; D006801:Humans; D057240:Patient Preference; D012426:Russia
keywords: Patient choice; Russian Federation; health policy; primary health care