The government's high-profile patient choice scheme is only being offered to three in 10 people, a survey for the Department of Health shows.
Patients were asked if they could choose where they had their operation
Since January 1, NHS patients have been allowed to choose between at least four local hospitals for an operation. Private clinics are also now available.
But the poll showed in May and June the worst areas offered a choice for first appointments to just 20% of patients.
The government said these primary care trusts (PCTs) would be offered support.
The Mori National Patient Choice Survey also found that only 29% of the 79,000 people questioned knew that they had a choice of hospital before they went for their appointment.
Of those who were offered a choice, only 20% were given an information booklet which they should have received.
Whether patients were offered choice depended on where they lived.
In 14 PCTs, more than 60% of patients were offered a choice but under 20% were given the option in 63 other PCTs.
The best-performing PCTS were West Cumbria, Broxtowe and Hucknall in Nottinghamshire, Burnley, Pendle and Rossendale in East Lancashire and North Devon.
The worst - with less than 10% of patients being offered choice - are Hastings and St Leonards in East Sussex, Bradford City Teaching PCT and Southend On Sea in Essex.
Early results for July suggest slight improvements, with 35% of patients offered a choice and 32% aware of a choice before they attended an appointment.
'Patients don't remember'
Responding to the survey, health minister Lord Warner said the figures were "not good enough".
"In 14 PCTS, at least 60% of patients were offered a choice by their GP for their first hospital appointment. These PCTs prove that choice can work.
"However, some PCTs have performed less well, and this has brought down the national average to 30% - this is not good enough, and we will need to support these PCTs to improve."
Lord Warner also announced a pilot project where information about hospital choice will be promoted in 27 libraries around the country.
These pilot areas are Derbyshire, Gloucestershire and seven London boroughs including Bromley, Southwark, Newham, Hackney, Greenwich, Haringey and Waltham Forest.
Dr Mike Dixon, head of the NHS Alliance which represents PCTs, said the figures did not reflect patients' experiences.
"Quite a few patients do not remember if they've been offered a choice.
"What means more than figures of 30% is to ask individual patients whether they were given the sort of choice they required.
"Ultimately it's about what local patients want. That means that local services should reflect that."
Dr Richard Vautrey, from the British Medical Association's GPs committee, said many patients are not taking choice on board.
He said: "The experience of most GPs is that patients are choosing to go to their local hospital when they are referred, and most refuse the `Choosing your hospital' booklet when it is offered to them."
Dr Vautrey said he was worried that the library scheme would stretch already burdened NHS resources.
"Whilst there is nothing wrong in principle in using libraries to promote the choice booklets, there is presumably a cost involved."