Impact of private funding on access to elective hospital treatment in the regions of England and Wales. National records survey.
BACKGROUND
The UK National Health Service aims to match access to health care to the level of need and to reduce inequalities in the health of sub-populations. One in ten persons have private medical insurance (PMI). This study describes the impact of private purchasing on access to hospital care in regions according to health need.


METHODS
Details of admissions to NHS hospitals in one year and waiting times were obtained from the government's Hospital Episodes Statistics, and of patients in independent hospitals through weighted time samples of records. Data were combined into two groups, state funded and privately funded patients. The prevalence of limiting longstanding illness and the proportions of individuals covered by PMI in Wales and the eight English health regions were obtained from the General Household Survey. Correlation coefficients were calculated for inter-regional relationships between measures of need, provision of resources and levels of activity.


RESULTS
Limiting, longstanding illness was significantly associated with NHS resource levels, NHS hospital activity, and total hospital activity, however funded; and inversely with PMI coverage, waiting times for NHS admission and levels of privately funded activity. Waiting times for admission were positively correlated with PMI coverage.


CONCLUSIONS
Regionally, NHS resources and activity match need. Private hospital use complements lower levels of NHS service. Private consumption does not distort access according to need but in regions with lower levels of NHS activity those least deprived may make relatively more use of NHS hospitals, thus widening the health gap. Small area studies should explore this.
Williams
B
B
School of Community Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
Whatmough
P
P
McGill
J
J
Rushton
L
L
D017558:Elective Surgical Procedures / Q000191:economics*; D004739:England; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000639:trends; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data*; D012935:Social Justice; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration*; D014850:Waiting Lists; D014852:Wales