Private sector treatment centres are treating less complex patients than the NHS

Abstract

SummaryObjectives In England, patients can choose to have their NHS elective care delivered by private (or 'independent sector') providers or by the NHS. Providers are paid a fixed tariff for each type of procedure. Our objectives were to compare NHS providers with private treatment centres in terms of (a) the quality of data coding and (b) patient complexity.Design We compared elective patients aged 18 years and over treated in the NHS and private sectors using the Hospital Episode Statistics (HES) data for [2007][2008]. The absence of diagnostic information was used as a measure of data quality. We analysed differences in complexity for each of the 30 Healthcare Resource Groups (HRGs) that together account for 78% of coded private treatment centre activity. Statistical significance was assessed at the 1% level. Setting Hospitals and treatment centres.Main outcome measures Patient complexity was assessed by four characteristics: age; number of diagnoses; number of procedures; and income deprivation of residential area.Results NHS providers treated almost 7 million adult elective patients in [2007][2008]. Fewer than 100,000 patients were treated by private providers (1.3% of elective activity). Less than 1% of NHS patients lacked diagnostic information compared to 36% of patients treated by private providers. For the top 30 HRGs, NHS patients had significantly (p<0.01) higher levels of co-morbidity, underwent more procedures and were more likely to come from deprived areas compared with patients treated by private providers. Although patients treated in private settings tended to be younger, the difference was not statistically significant.Conclusions Some private companies provide poor quality data. In general, the NHS is treating more complex patients than private providers. If complexity drives costs, then a fair reimbursement system would require higher payments for NHS providers.

Does hospital competition harm equity? Evidence from the English National Health Service

“…percentage points lower in a recent study of 2007/8 data covering 78% of procedures coded in IS activity (Mason et al 2010). Furthermore, IS activity makes up a relatively small proportion of NHS activity in the early years of the ISTC programme when coding was particularly poor -less than 1% until 2006/7 -and activity coding has improved since then (NHS Information Centre 2009).…”

“…On the supply side, independent sector (IS) providers were encouraged to enter the market for publicly funded NHS patients, initially through the "Independent Sector Treatment Centre" programmeme of nationally agreed contracts with generous terms (Mason et al, 2010 should be offered a choice of four or five hospitals including one independent sector provider, leading up to "free choice" of any public or independent hospital in the NHS national directory from April 2008 (Dixon et al, 2010). This was coupled with a national system of fixed price case based hospital payment based on a local variant of DRGs ("Healthcare Resource Groups"), which was gradually phased in nationally from 2003/4 for a small basket of elective inpatient services and progressively expanded to include all elective services in 2005/6.…”

Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008

“…First, this was an ecological study and we can only Table SA3). Furthermore, IS patients were not much more likely to live in affluent areas than other NHS patients: one study found mean area deprivation of IS patients was only 1.56 percentage points lower [33].…”

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

“…Risks include higher transaction costs, increased inequality across population groups, and increased problems with F o r P e e r R e v i e w 5 recruitment and retention of health professionals in the public sector. Empirical evidence from the UK supports that outsourcing in the health care sector may increase selection problems (Chard et al 2011, Mason, Street, and Verzulli 2010). …”