DRAFT – NOT FOR CITATION 1 Do
نویسندگان
چکیده
Major reforms were introduced into the English NHS in the early to mid 2000s, helping to reduce waiting times and length of stay for elective surgery. One concern, however, is that efficiency-oriented reforms may harm equity by giving hospitals an incentive to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the likely magnitude of any such selection incentive in the test case of hip replacement. Anonymous hospital records are extracted on all 235,813 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled using linear regression, allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type), year effects and Trust effects. Allowing for these factors, patients from the most deprived tenth of areas stayed 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. Potential incentives for NHS hospitals to select hip replacement patients by deprivation status are comparatively small.
منابع مشابه
DRAFT: DO NOT QUOTE OR CITE DRAFT: DO NOT QUOTE OR CITE 1 Designing Probability Samples to Study Treatment Effect Heterogeneity
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