Abstract
BackgroundThere is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals.MethodsData were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays.ResultsAmong 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days).ConclusionAt 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.
Highlights
Public health care is usually provided by the government through national healthcare systems, whereas private health care is often provided as “for profit” services
We considered patients eligible for the study if they had a diagnosis of symptomatic paramedian lumbar disc herniation, surgery was performed as a single-level lumbar microdiscectomy, and their data were included in the NORspine registry
There were no differences between non-responders and responders at 1 year for preoperative Oswestry disability index (ODI), preoperative back pain, preoperative leg pain, preoperative EQ-5D, comorbidity, or American Society of Anesthesiologists (ASA) grade
Summary
Public health care is usually provided by the government through national healthcare systems, whereas private health care is often provided as “for profit” services. Ideological debates whether countries should strengthen public versus private healthcare services are common. There is currently limited and only poor-quality evidence regarding the comparative performance of the two health care systems [2]. In order to achieve a more informed policy, there is an urgent need for robust evidence by comparing the quality and effectiveness of the health care provided through both systems. Surgical management of degenerative lumbar spine disorders is provided by both public and private hospitals, providing a unique opportunity to compare the two health care provider systems. The aim of this study was to compare patient-reported outcomes following surgery for lumbar disc herniation (LDH) because of sciatica in public versus private hospitals. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals
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