Awarding NHS contracts to private providers decreased local NHS provision and increased inequalities: Scottish case study of elective hip arthroplasty

Abstract

Background This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities. Methods An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 01 April 1993 to 31 March 2013. Results Increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13 territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002. Conclusions NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.