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P08 The analysis of private healthcare patterns in England: an emerging two-tier system
  1. L McCann1,
  2. I Holdroyd2,
  3. R Emberson3,
  4. H Painter1,
  5. J Ford1
  1. 1Wolfson Institute of Population Health, London, UK
  2. 2University of Cambridge, UK
  3. 3Queen Mary University, London, UK

Abstract

Background Private healthcare is a rapidly growing industry in the UK, particularly for surgical procedures. Across the pandemic period, waiting lists for elective surgical and consultant-led care increased from 4.4 to 7.5 million patients, with no signs of improvement. Simultaneously, private insurance and out-of-pocket healthcare expenditure in the UK has increased fastest of all G7 nations. This study aimed to analyse the trends and geographical variations in privately funded and NHS-funded orthopaedic private procedures across England compared to NHS waiting times.

Methods We conducted a longitudinal study using quarterly national data between 2019 and 2023 in England. Descriptive analysis of orthopaedic surgical volumes per 10,000 people, and wait times stratified by geographical location and time period was conducted. Independent variables were: the waiting list length and geographical area (either region or north-south).

Results Between 2019 and 2023 there were a total of 1,469,450 procedures across the private sector, comprising 1,030,095 NHS-commissioned private orthopaedic procedures and 439,355 private orthopaedic procedures. This is equivalent to 42/10,000 people and 18/10,000 people per year respectively. The South of England performed a higher total number of private procedures per year compared to the North (63 vs 57/10,000 people); whilst there was almost double the number of privately funded procedures (23 vs 12/10,000), there were less NHS-funded procedures (45 vs 40/10,000 respectively). There was a large variation in the number of NHS-funded procedures per 10,000 between regions; notably, London had less than half the number of procedures when compared to the Southwest (26 vs 56/10,000) despite having the same number of privately funded procedures (22/10,000). The North has consistently shorter waiting times than the South.

Conclusion Our findings indicate considerable geographical variation in use of private healthcare between regions within England, suggesting a two-tier healthcare system. The founding principles of the NHS, healthcare free at the point of use based on clinical need irrespective of ability to pay, continue to be eroded. Policy makers and politicians urgently need to find solutions to ensure all members of society can access the same high quality health care.

  • private healthcare
  • health inequalities
  • equity.

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