Changes in publicly and privately funded care in England following a national programme to reduce provision of low-value elective surgery.

Abstract

This study assessed whether there is an association between changes in publicly and privately funded care for procedures classified as low value by the National Health Service (NHS) in England following implementation of the Evidence-Based Intervention (EBI) programme. Category 1 procedures should not be conducted and are no longer reimbursed by the NHS. Category 2 procedures are only reimbursed by the NHS in certain circumstances. Changes in volumes of publicly and privately funded procedures per month in 2019-2020 compared with the previous year were analysed in private hospitals and local healthcare markets, and adjusted for volume of procedures and patient case mix including age, sex, co-morbidities, and deprivation. Supplementary analyses focused on the self-pay and insurance funding mechanisms. There was a statistically significant association between changes in publicly and privately funded care for category 2 procedures at the hospital (-0.19, 95 per cent c.i. -0.25 to -0.12) and local healthcare market level of analysis (-0.24, -0.32 to -0.15). A statistically significant association for category 1 procedures only existed at the hospital level of analysis (-0.19, -0.30 to -0.08). Findings were similar for patients accessing care through self-pay and insurance funding mechanisms. Stronger associations between changes in publicly and privately funded care for category 2 procedures may exist as they are clinically indicated in certain circumstances. Reductions in publicly funded care were likely a combined result of the EBI programme and growing NHS waiting lists, whereas increases in privately funded care were influenced by both patient and supplier-induced demand.