Patient choice in healthcare in england and sweden: From quasi-market and back to market? A comparative analysis of failure in unlearning

This paper compares elements of choice introduced under the market orientated reforms in health systems in the UK and Sweden in the 1990s, and the recent patient choice policy in both countries. It reviews empirical evidence on the impact of choice on users and services under these reforms to examine whether, and how far, these past developments have informed the current choice reforms. The paper asserts that the reappearance of issues and solutions in patient choice policy in the English NHS and in Sweden signifies limited learning from their own past and cross-national experience, resulting in blurred and mutually exclusive policy agendas. The study argues that this absence of learning happens because of the seeming inability of governments and policy-makers to unlearn effectively their preconceived ideas and schemas, pointing out the limitations of social learning theory in understanding health policy development.