Healthcare quality in NHS and private hospitals in England

Anderson, Michael James (2023) Healthcare quality in NHS and private hospitals in England. PhD thesis, London School of Economics and Political Science.

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Abstract

Elective care in England is provided by NHS and private hospitals through a combination of public and private funding. There are concerns regarding healthcare quality in private hospitals and the need to ensure value for money in the context of increasing provision of publicly funded care in private hospitals. Private hospitals also may engage with risk selection, treating less complicated patients than NHS hospitals highlighting the complex interaction between the public and private sectors in servicing NHS patients. Against this background, the Evidence-Based Interventions (EBI) programme was implemented in April 2019 to reduce the provision of low value procedures, produce cost-savings and improve healthcare quality. This thesis focuses on these developments through several perspectives. Paper I focuses on publicly funded care and uses a difference-in-difference analysis to conclude the EBI programme did not accelerate disinvestment for the procedures under its’ remit in the first year after implementation. Using triple difference estimation, this paper shows that reductions in provision of low value procedures were larger in NHS hospitals than in private hospitals. Paper II focuses on privately funded care in private hospitals and identifies evidence of substitution after the implementation of the EBI programme, in the reductions in publicly funded care, and increases in privately funded care. This paper produces stronger evidence of substitution for procedures classified as low value in certain circumstances and beneficial in others, and weaker evidence of substitution for procedures classified as low value in any circumstances. Paper III focuses on publicly funded care and uses methods to adjust for observable confounders to show that elective orthopaedic care in private hospitals is safer, produces better outcomes, and is more efficient. Using an instrumental variable approach to account for both observable and unobservable confounders, there are contrasting results and no evidence of differences in relation to patient safety and outcomes. Using this approach, treatment in private hospital is also associated with longer post-operative length of stay.

Item Type:	Thesis (PhD)
Additional Information:	© 2023 Michael James Anderson
Library of Congress subject classification:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine
Sets:	Departments > Health Policy
Supervisor:	Mossialos, Elias and McGuire, Alistair
URI:	http://etheses.lse.ac.uk/id/eprint/4709

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