Choosing not to choose—Patients' justification of a disengaged choice of primary care provider

Abstract

A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi‐structured interviews with 18 respondents in a municipality in mid‐Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient‐doctor relationship than ‘shopping around’ for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the ‘patient‐consumer’ role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.