© Institute for Fiscal Studies and Nuffield Trust, 2013May 2013Public payment and private provisionThe changing landscape ...
© Institute for Fiscal Studies and Nuffield Trust, 2013Trends in public and private health care spending
© Institute for Fiscal Studies and Nuffield Trust, 2013Proportion of secondary care spending on private providers
© Institute for Fiscal Studies and Nuffield Trust, 2013Regional variation in NHS spending on private providers
© Institute for Fiscal Studies and Nuffield Trust, 2013Public and private spending on hip and knee replacements• The spend...
NHS-funded knee and hip replacements (2003/04 – 2011/12)NHS-funded knee and hip replacements increased by 52% and 45%, res...
Change in NHS-funded hip & knee replacements by providertypeIndependent sector providers (ISPs) account for more than half...
© Institute for Fiscal Studies and Nuffield Trust, 2013What explains the increase in NHS-funded activity?• The increase in...
© Institute for Fiscal Studies and Nuffield Trust, 2013Examining substitution between NHS- and privately fundedcare• To wh...
Three-year aggregates of hip and knee replacements recordedin the National Joint Registry and Hospital Episode StatisticsT...
© Institute for Fiscal Studies and Nuffield Trust, 2013Evidence of substitution from the privately funded toNHS-funded sec...
© Institute for Fiscal Studies and Nuffield Trust, 2013Conclusions• Spending patterns are mirrored by changes in the provi...
© Institute for Fiscal Studies and Nuffield Trust, 2013For more information about the Nuffield Trust,including details of ...
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Sandeepa Arora & George Stoye: Private health care provision

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Sandeepa Arora & George Stoye: Private health care provision

  1. 1. © Institute for Fiscal Studies and Nuffield Trust, 2013May 2013Public payment and private provisionThe changing landscape of health care in the 2000sSandeepa Arora, Nuffield Trust and George Stoye,Institute for Fiscal StudiesUnderstanding competition and choice in the NHS
  2. 2. © Institute for Fiscal Studies and Nuffield Trust, 2013Trends in public and private health care spending
  3. 3. © Institute for Fiscal Studies and Nuffield Trust, 2013Proportion of secondary care spending on private providers
  4. 4. © Institute for Fiscal Studies and Nuffield Trust, 2013Regional variation in NHS spending on private providers
  5. 5. © Institute for Fiscal Studies and Nuffield Trust, 2013Public and private spending on hip and knee replacements• The spending patterns that we observe previously may beconsistent with some ‘crowding-out’ of private spending.• The extent to which this occurs is difficult to assess directlyusing aggregate spending data.• This part of the report focuses on the case of elective hip andknee replacements.• Provided and funded by both private and public sector.
  6. 6. NHS-funded knee and hip replacements (2003/04 – 2011/12)NHS-funded knee and hip replacements increased by 52% and 45%, respectively,between 2003/4 and 2011/12.© Institute for Fiscal Studies and Nuffield Trust, 2013
  7. 7. Change in NHS-funded hip & knee replacements by providertypeIndependent sector providers (ISPs) account for more than half the increasein NHS-funded hip and knee replacements between 2003/4 and 2010/11© Institute for Fiscal Studies and Nuffield Trust, 2013
  8. 8. © Institute for Fiscal Studies and Nuffield Trust, 2013What explains the increase in NHS-funded activity?• The increase in NHS operations may suggest that somepatients are now having procedures that they would otherwisenot have had or would have had much later.• However, the rise in operations may also be explained by:• Demographic change• Some patients switching from privately funded to NHS funded-care.• Our estimates suggest that population ageing accounts for afifth of the increase in hip replacements and a sixth of the risein knee replacements.
  9. 9. © Institute for Fiscal Studies and Nuffield Trust, 2013Examining substitution between NHS- and privately fundedcare• To what extent are patients that would have paid privately adecade ago now choosing NHS-funded care?• For most procedures very limited information is available onthe privately funded activity.• For hip and knee replacements, we can address this questionby comparing two data sources:• National Joint Registry (NJR): hospital-level data on all hip and kneereplacements conducted in England and Wales.• Hospital Episodes Statistics (HES): patient-level on NHS-funded hipand knee replacements in England.
  10. 10. Three-year aggregates of hip and knee replacements recordedin the National Joint Registry and Hospital Episode StatisticsTotal hip and knee implant sales, as recorded by the NJR, changed little between 2003/4and 2011/12. However, the number of NHS-funded hip and knee replacements, asrecorded in HES, increased by a third. © Institute for Fiscal Studies and Nuffield Trust, 2013
  11. 11. © Institute for Fiscal Studies and Nuffield Trust, 2013Evidence of substitution from the privately funded toNHS-funded sector• Aggregate evidence is consistent with some substitution fromprivately funded to NHS-funded knee and hip replacements.• Evidence from individual providers tells a similar story:• Decreasing volumes of NHS private patients and independentprivate hospital patients.• Falls in numbers of privately funded procedures for ISPs that treatboth private and NHS patients.
  12. 12. © Institute for Fiscal Studies and Nuffield Trust, 2013Conclusions• Spending patterns are mirrored by changes in the provision ofNHS-funded elective knee and hip replacements.• Increased volumes over and above which can be explained bydemographic changes• More than half of the increases are accounted for by ISPs.• Overall volume of these procedures remained relatively stableover the same period.• Falling private volumes• Suggestive of substitution from the private to publicly fundedsector.
  13. 13. © Institute for Fiscal Studies and Nuffield Trust, 2013For more information about the Nuffield Trust,including details of our latest research andanalysis, please visit www.nuffieldtrust.org.ukFor more information about the Institute forFiscal Studies, please visit www.ifs.org.uk© Institute for Fiscal Studies and Nuffield Trust, 2013The Institute for Fiscal Studies is a leadingmicroeconomic research institute, aiming topromoting effective economic and socialpolicies.The Nuffield Trust is an authoritative andindependent source of evidence-basedresearch and policy analysis for improvinghealth in the UK.

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