title: Comparison of NHS and private patients undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy.
abstract: OBJECTIVE
  To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately.
  
  
  METHODS
  Cohort study of patients recruited by 25 surgeons during 1988.
  
  
  METHODS
  Hospitals in Oxford and North West Thames regions.
  
  
  METHODS
  Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients.
  
  
  METHODS
  Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively.
  
  
  RESULTS
  NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001).
  
  
  CONCLUSIONS
  Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.
authors.affiliation: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.forename: M
authors.initials: M
authors.lastname: Pettigrew
authors.forename: K
authors.initials: K
authors.lastname: McPherson
mesh_terms: D015897:Comorbidity; D003659:Decision Making, Organizational; D017558:Elective Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D017149:Private Sector / Q000592:standards / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000592:standards / Q000706:statistics & numerical data*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D013222:State Medicine / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014600:Utilization Review; D014850:Waiting Lists