University of York, York YO10 5DD, UK.
Soc Sci Med. 2011 Jan;72(2):173-84. doi: 10.1016/j.socscimed.2010.11.001. Epub 2010 Nov 18.
The Blair/Brown reforms of the English NHS in the early to mid 2000s gave hospitals strong new incentives to reduce waiting times and length of stay for elective surgery. One concern was that these efficiency-oriented reforms might harm equity, by giving hospitals new incentives to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the magnitude of these new selection incentives in the test case of hip replacement. Anonymous hospital records are extracted on 274,679 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type) and hospital effects. After adjusting for these factors, we find that patients from the most deprived tenth of areas stayed just 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. We conclude that the Blair/Brown reforms did not give NHS hospitals strong new incentives to select against socio-economically deprived hip replacement patients.
21 世纪初至中期，布莱尔/布朗对英国国民医疗服务体系（NHS）进行了改革，使医院有了更强的动力来减少择期手术的等候时间和住院时间。人们担心这些以效率为导向的改革可能会损害公平性，因为这会使医院产生新的激励机制，选择那些社会经济地位较低、住院时间较长、治疗费用较高的患者。本文旨在评估这些新的选择激励机制在髋关节置换这一案例中的重要性。从 2001 年 2 月至 2007 年 8 月，从英国国民医疗服务体系医院信托机构中提取了 274679 名接受择期全髋关节置换术的患者的匿名医院记录。通过允许其他患者特征（年龄、性别、诊断数量和类型、手术类型）和医院效应，对住院时间与小面积收入剥夺之间的关系进行建模。在调整了这些因素后，我们发现，2001 年 2 月，来自最贫困十分之一地区的患者比其他地区的患者住院时间仅长 6%，到 2007 年 8 月降至 2%。相比之下，2001 年 2 月，85 岁及以上的患者比其他患者住院时间长 57%，到 2007 年 8 月上升至 71%，而诊断七次或以上的患者比其他患者住院时间长 58%，到 2007 年 8 月上升至 73%。我们的结论是，布莱尔/布朗的改革并没有给英国国民医疗服务体系的医院带来强烈的新激励机制，以选择那些社会经济地位较低的髋关节置换患者。
