Mapping choice in the NHS: Analysis of routine data (original) (raw)
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Mapping choice in the NHS: cross sectional study of routinely collected data
BMJ, 2005
Objective To identify where in England there are likely to be most constraints on choice of hospital for patients waiting longer than six months for elective care. Design Cross sectional study using routinely collected data. Setting Population of England and NHS trusts and private sector hospitals in England. Participants All residents in England. Main outcome measures Availability of beds (available and unoccupied hospital beds), demand (number of people waiting longer than six months), and access (travel time to facilities) to hospital care in England. Results Most people in England already have an extensive potential choice of hospital. The number of available and unoccupied beds within 60 minutes' travel time was lowest in the Scottish borders, North Yorkshire, and parts of East Anglia, Lincolnshire, Devon, and Cornwall. This pattern was not altered by adding in private facilities. Putting demand with this supply, the number of people in a geographical area waiting longer than six months per bed within 60 minutes' travel time was highest in the south east (except London), parts of the south west (Cornwall, Bristol), East Anglia, and the Welsh border. Conclusion People in the south east (outside London), East Anglia, and parts of the south west are likely to have to travel further to exercise meaningful choice of hospital for elective care.
2018
We study hospital choice in the publicly funded National Health Service in England, using a two sample strategy to identify a structural model of demand for elective procedures. In the NHS patients are allowed to opt out from the market of free-of-charge public hospitals and choose a private provider; we find that the outside option has an important effect on competition, patient choice and elasticities compared with traditional models ignoring the private sector. Considering endogeneity of waiting-time, proper measures of quality and the existence of private sector, we find substantially different policy conclusions compared to existing hospital demand models.
Journal of Health Services Research & Policy, 2013
Objectives To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). Results GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offe...
Objectives: To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods: Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). Results: GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. Conclusions: There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them.
The determinants of hospital utilisation: Implications for resource allocation in England
Health Economics, 1994
Since 1976 various attempts have been made to ensure that NHS resources available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The current method is based on analyses of the links between observed patterns of in-patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this approach, however, and so the search continues for new analytical techniques.
Environment and Planning A: Economy and Space, 2003
The availability of choice is a neglected aspect in studies of geographical accessibility, which typically concentrate on distance to the nearest service. Records of patient registrations with general medical practices offer the opportunity to examine the geographical distribution of choice for an essential service. This population study of two million residents of Cambridgeshire, Norfolk, and Suffolk used postcodes extracted from patient registers and estimated car travel times from residential locations to general practice surgeries in a geographic information system. Only 56% of the population were registered with the practice nearest their home. People were more likely to use the nearest practice if they lived in rural rather than urban areas and where a surgery was within walking distance. Choice, as measured by the number of practices used by 95% of residents, was highest in the larger urban areas and lowest in small towns and rural areas with a local surgery. Ten percent of t...
Differences in durations of stay for surgery in the NHS and private sector in England and Wales
BMJ, 1985
Median durations of stay in England and Wales for eight "marker" operations were consistently shorter for patients in pay beds in the National Health Service than for patients in independent acute hospitals or public sector beds. This pattern was seen for both preoperative and postoperative stay and among specific age groups. Differential use of other hospitals for part of the period of care was not a factor, except for patients having hip replacement operations treated in NHS pay beds, one in seven of whom appeared to transfer-to public sector care postoperatively. These findings suggest that there is scope for a possible further reduction in durations of stay in public sector beds and, within the private sector, for an assessment of whether spells in independent hospitals need be longer than in NHS pay beds. Introduction In 1981 one eighth of all elective surgical operations on residents of England and Wales were performed in the private sector, with a ratio of three in independent hospitals to one in pay beds in National Health Service hospitals.' The types of elective operation performed in the NHS and private sector were similar, but median durations of stay were observed to be generally shortest in NHS pay beds, intermediate in independent hospitals, and longest in NHS beds. One possible explanation for this is that managerially the private sector is more efficient. If this is the case, and assuming similar clinical outcomes, the NHS may be challenged to match the performance of the private sector. In this paper we explore these differences further and discuss their importance. Methods Data from the Hospital Inpatient Enquiry for 1980, the latest available year, covering a 10% sample of discharges of inpatients from NHS nonpaying beds and pay beds in England and Wales, were supplied on magnetic tape by the Office of Population Censuses and Surveys. The records of a sample of 12 959 patients drawn from 150 of the 153 independent acute hospitals functioning at any time in England and Wales in 1981 were abstracted. The method of sampling and the way in which estimates were obtained for independent hospitals have been described
Is Patient Choice an Effective Mechanism to Reduce Waiting Times?
Applied Health Economics and Health Policy, 2004
initiatives in secondary care are part of policies aimed at reducing waiting times. This article provides evidence on the effectiveness of patient choice as a mechanism to reduce waiting times within a metropolitan area. The London Patient Choice Project was a large-scale pilot offering patients on hospital waiting lists a choice of alternative hospitals with shorter waiting times. A total of 22 500 patients were offered choice and 15 000 accepted. The acceptance rate of 66% was very high by international standards. In this article we address two questions. First, did the introduction of choice significantly reduce waiting times in London relative to the rest of the country where there was no choice? Second, how were the waiting times of London patients not offered choice affected by the choice regime? We examine the evidence on these issues for one specialty, orthopaedics. A difference-indifference analysis is used to compare waiting times for hospitals within London before and after the introduction of choice. Although there was a small but significant reduction in waiting times in London relative to other areas where there was no patient choice, the main effect of the choice regime was to produce convergence of mean waiting times within London. Convergence was achieved by bringing down waiting times at the hospitals with high waiting times to the levels that prevailed in hospitals with low waiting times. This represented a clear improvement in equity of access, an important objective of the English National Health Service.