Private funding of elective hospital treatment in England and Wales, 1997-8: national survey

Abstract

Methods and resultsInformation on patients admitted as inpatients or day cases during sample periods in financial year 1997-8 were obtained from 215 of 221 acute independent hospitals with operating departments in England and Wales 2 ; data obtained included the patient's clinical status, demographic information, and source of funding for the procedure. Numbers for the whole year were estimated by weighting the sample data according to the duration of sampling, the time of year, and the number of hospitals that did not respond; these numbers were validated as previously described.3 Extracts of the latest data (for 1996-7) were obtained from the Department of Health and the Welsh Information Agency's hospital episodes statistics for waiting lists and scheduled admissions for NHS and private patients admitted for non-psychiatric, non-maternity care. Data for first consultant episodes (98% of all consultant episodes for elective patients and equivalent to the number of admissions) and data from independent hospitals were analysed using SPSS statistical software. Although these two sources of data were out of phase by a year, hospital episodes in the NHS for general and acute specialties rose only 2% between 1996-7 and 1997-8 (NHS Executive, personal communication, 1999.Altogether 739 810 of 5 094 404 patients (14.5%) had had private funding, and 591 755 of 4 415 334 surgical patients (13.4%) had had private funding (table). One in 10 private patients were treated in NHS hospitals, and 1% of NHS patients were treated in independent hospitals. Of the private admissions, 81% were funded by insurance and 18% were funded by the patient. CommentThe proportion of elective treatments purchased privately has remained constant over nearly two decades. Although NHS patients and private patients receive a similar range of treatments the types of procedure differ proportionately. A higher than average proportion of patients pay for operations that relieve severe disability or discomfort-such as total replacement of the hip joint, which had a median NHS waiting time of 168 days in 1996-7, and lens operations for cataract (median waiting time 144 days)-and for those for which delay may increase the risk of dying, such as coronary artery operations (94 days).

Health Care for Older Persons in England and the United States: A Contrast of Systems and Values

“…Estimates of the number of private revascularizations not included in the HES dataset varies from 7 to 30 percent (Black, Langham, and Petticrew 1995; Williams et al 2000), and 12.5 percent in London (Mindell et al 2008), so the national differences in the use of revascularization may not be as large as these data suggest. As we discuss below, however, counting privately financed revascularization may point to even greater, inequalities in access among older persons.…”

“…It is likely that the English rates are underestimated because of the exclusion of those surgeries that are paid for privately. This could amount to 25 percent of the total surgeries performed (Williams et al 2000). The proportion of private surgeries is likely to be highest among the youngest age groups because, unlike in the United States, in England private insurance coverage is highest among those aged fifty-five to sixty-four because it is usually an employment benefit (Eoubister et al 2006).…”

Private medical services in acute‐care hospitals in Israel

“…Appleby and Yates (1995) estimated that in 1986 about 20% of the elective surgical procedures were carried out in private beds in public hospitals. More recent data on private funding of elective hospital treatment in England and Wales in 1997±8 (Williams et al, 2000) indicated that 14.5% of the patients had had private funding. However, only one in ten private patients were treated in NHS hospitals and only 1.6% of the total number of surgical and medical procedures performed in NHS hospitals concerned privately funded patients.…”

“…However, only one in ten private patients were treated in NHS hospitals and only 1.6% of the total number of surgical and medical procedures performed in NHS hospitals concerned privately funded patients. Of the private admissions, 81% were funded by insurance and the patient funded 18% (Williams et al, 2000). In the UK, as in Israel, over two-thirds of the hospital-based operations are customarily not elective (Appleby and Yates, 1995).…”

Surgical waiting lists are inevitable: time to focus on work undertaken

“…Despite the steady increase in the number of publicly funded operations conducted in England during the 1970s and 1980s, the number privately funded rose in tandem, maintaining a steady 13-15% of all procedures. 5 This suggests that the average surgeon chose to spend about 14% of his or her time operating privately and this proportion did not change over two decades, despite major increases in the number of public sector operations.…”