Analysis of orthopaedic private healthcare patterns in England: A potential emerging two-tier system.

Objectives: Private healthcare is a rapidly growing industry in the UK, particularly for surgical procedures, due to extensive waiting times in publicly funded health care. The NHS also commissions private healthcare to provide procedures for NHS patients to alleviate waiting times. We aimed to explore the trends and geographical variations between the North and South of England in privately funded and NHS-funded privately delivered orthopaedic procedures compared to NHS waiting times. Study design: A longitudinal study using quarterly national data between 2019 and 2023 in England. Methods: We analysed orthopaedic surgical volumes per 10,000 people using Private Healthcare Information Network data in England from 2019 to 2023 and compared them with waiting times in publicly funded health care provided by the NHS. We stratified by geographical location and time period to compare the North-South divide in England. Results: The south of England performed almost double the number of privately funded procedures (23 vs 12/10,000), but there were fewer NHS-funded private procedures (40 vs 45/10,000). The north of England has consistently shorter waiting times than the South, with considerable variation across regions. London had fewer NHS-funded procedures compared to other regions. Conclusions: The time-trend patterns indicate considerable geographical inequalities of access to orthopaedic private healthcare between regions within England, with a potential emergence of a two-tier healthcare system. Relying on the private sector to reduce waiting lists, without oversight, may exacerbate regional and socioeconomic differences. Policymakers should consider how the unequal distribution of funding and NHS-funded procedures could perpetuate inequalities.