title: NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives.
abstract: OBJECTIVE
  Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses routinely collected NHS Scotland data to analyse geographical and socioeconomic inequalities in elective hip arthroplasty treatment before and after the introduction of the waiting time initiatives in Scotland in 2003.
  
  
  METHODS
  Ecological study design.
  
  
  METHODS
  Scotland.
  
  
  METHODS
  NHS-funded patients receiving elective hip arthroplasty delivered by the NHS and private hospitals between 1 April 1998 and 31 March 2008.
  
  
  METHODS
  Directly standardised treatment rates and incidence rate ratios calculated using Poisson regression.
  
  
  RESULTS
  There was a 42% increase in NHS-funded hip arthroplasties carried out in Scotland from 4095 in 2002-2003 (1 April 2002-31 March 2003) to 5829 in 2007-2008. There is evidence of a statistically significant reduction in geographical inequality (likelihood ratio test p < 0.001) but no evidence of any statistically significant change in socioeconomic inequality (p = 0.108), comparing the 5 years after 1 April 2003 with the 5 years before 1 April 2003. The number of NHS-funded hip arthroplasties undertaken privately rose from 1.1% in 2002-2003 to 2.9% in 2007-2008, whereas the NHS Golden Jubilee National Hospital increased its share from 3.3% to 10.6% over the same period.
  
  
  CONCLUSIONS
  The reduction in geographical inequality, or 'postcode lottery', in hip arthroplasty treatment in Scotland may be due to increased NHS capacity, in particular the development of the NHS Golden Jubilee National Hospital in Clydebank, Greater Glasgow as a dedicated centre to reduce surgery waiting times.
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 2AB, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Kirkwood
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 2AB, UK a.pollock@qmul.ac.uk.
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Pollock
authors.affiliation: Lothian University Hospitals NHS Trust, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Howie
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh EH8 9AG, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wild
keywords: epidemiology; geography; inequality; orthopaedics; socioeconomic deprivation; surgery