ArticleJournal of the Royal Society of Medicine2019
An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.
Article in Journal of the Royal Society of Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The trial behind it
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Mapping strategies for reducing inequalities in adult elective surgical care in the United Kingdom: a living scoping review.BMC health services research · 2026Article
- Outsourcing National Health Service Surgery to the Private Sector: Waiting Time Inequality and the Making of a Two-Tier System for Hip and Knee Replacement in England.International journal of social determinants of health and health services · 2025Article
- Observational
- Article
- The return of inverse care: Case study of elective hip surgery.The Lancet regional health. Europe · 2022Article
- Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies.Journal of the Royal Society of Medicine · 2022Article
- Article
- Article
- Health is politics writ large and small.Journal of the Royal Society of Medicine · 2019Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo examine the impact of NHS-funded private provision on NHS provision, access and inequalities.
designEcological study using routinely collected NHS inpatient data.
settingEngland.
participantsAll individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013.
main outcome measuresAnnual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013.
resultsAge standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4-117.4) to 148.7 (147.6-149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2-11.5) to 35.4 (34.3-36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1-9.4) to 25.2 (24.1-26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013.
conclusionPrivate provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.
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