In the run up to the next general election greater choice for patients over where to be treated is emerging as the big political idea. Ironically, while choice is being promoted in health care, there seems to be very little to choose between the two main political parties on this aspect of health policy. Last week the secretary of state for health, John Reid, announced an expansion of the Labour government's choice programme—and his Conservative opposite number, Andrew Lansley, did the same.1 2 However, look closely and some differences start to emerge. But will the power to choose really improve health outcomes for all?

By 2008, the government says that every patient who needs to be referred by their general practitioner (such gatekeeping is to be retained) for a specialist outpatient consultation will have the choice of any NHS or private provider, or any one of the new treatment centres that are often run as public-private enterprises.3 …