Search

Objectives: To examine the impact of NHS-funded private provision on NHS provision, access and inequalities.Design: Ecological study using routinely collected NHS inpatient data.Setting: England.Participants: All individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013.Main Outcome Measures: Annual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013.Results: Age standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4-117.4) to 148.7 (147.6-149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2-11.5) to 35.4 (34.3-36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1-9.4) to 25.2 (24.1-26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013.Conclusion: Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England. [ABSTRACT FROM AUTHOR]

The article focuses on the effect of legislative amendments to the Health and Social Care Bill to the health services in Great Britain. It states that the duty of primary care trusts (PCT) will be abolished to secure everyone's health services in a defined area. It mentions the establishment of a parallel health service in the local authority sector and restrictions for clinical commissioning groups (CCGs). It concludes that the amended bill fails to discuss clearly who will be responsible for the health services of the people and creates new charging powers. INSET: PUBLIC HEALTH FUNCTIONS THAT ARE SUBJECT TO NEW CHARGING POWERS.

The article looks at the extent of the changes to community pharmacy in Great Britain under the revision of the National Health Service (NHS) community pharmacy contract. Reforms were implemented by the British government in 2005 aimed at increasing access and patient choice, reduce general practitioner workload and lower costs to the NHS. An overview of the community pharmacy market is presented, as well as changes to control of entry regulation and an analysis of its implications for primary care.

This article focuses on a plan by the British coalition government to open up the market in the National Health Service (NHS). It notes the growing scepticism about the merit of the private sector in U.S. health care, as well as the proposal in Great Britain to devolve financial risk to general practice consortiums through market competition and a reimbursement system. It points out the risk posed by mentally ill patients due to their higher overall health costs and unpredictable care. It also notes the development of the competitive market of mixed providers, as well as the effect of competition in the NHS on quality and efficiency.