This seminar is organized by the Health Policies research group:

Thursday 6 March
Sciences Po, K011
1 place Saint-Thomas d'Aquin
12h30 - 14h30

Speaker

Dr Michael Anderson, NIHR Clinical Lecturer, Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester

Abstract

Since the early 2000s, the National Health Service (NHS) in England has expanded provision of publicly funded care in private hospitals as a strategy to meet growing demand for elective care. This study aims to compare patient outcomes, efficiency and adverse events in private and NHS hospitals when providing elective hip and knee replacement. The study employs advanced statistical techniques, including probit regression, instrumental variable (IV) analyses using differential distance to nearest private and NHS hospital, and propensity score matching, to adjust for both observable and unobservable confounders at the patient-level. Patients treated in private hospitals tend to be less complex, potentially due to preferential contractual arrangements or patient and clinician preferences. Probit regression suggests better outcomes in private hospitals, such as reduced probabilities of mortality, readmissions, transfers, and adverse events. However, IV analyses reveal no significant differences in most outcomes, except for lower rates of hospital-associated infections in private hospitals and longer post-operative stays. The findings challenge the prevailing notion that private hospitals offer superior care, indicating comparable healthcare quality between private and NHS hospitals. This underscores the importance of systematic monitoring of patient outcomes in the private sector and further research into reimbursement adjustments to address differences in patient case-mix.

Published paper relevant to policy evaluation: Anderson M, Friebel R, Maynou L, Kyriopoulos I, McGuire A, Mossialos E. Patient outcomes, efficiency, and adverse events for elective hip and knee replacement in private and NHS hospitals: a population-based cohort study in England. Lancet Reg Health Eur. 2024 Apr 17;40:100904. doi: 10.1016/j.lanepe.2024.100904. PMID: 38680249; PMCID: PMC11047790.