Equity, waiting times, and NHS reforms: retrospective study

作者：Zack Cooper, Alistair J McGuire, Simon Jones, Julian Le Grand · 发表于：BMJ · 年份：2009 · DOI：10.1136/bmj.b3264 · 被引用次数：119 · 研究领域：Healthcare Operations and Scheduling Optimization、Healthcare Policy and Management、Total Knee Arthroplasty Outcomes

OBJECTIVE: To determine whether observable changes in waiting times occurred for certain key elective procedures between 1997 and 2007 in the English National Health Service and to analyse the distribution of those changes between socioeconomic groups as an indicator of equity. DESIGN: Retrospective study of population-wide, patient level data using ordinary least squares regression to investigate the statistical relation between waiting times and patients' socioeconomic status. SETTING: English NHS from 1997 to 2007. PARTICIPANTS: 427,277 patients who had elective knee replacement, 406,253 who had elective hip replacement, and 2,568,318 who had elective cataract repair. MAIN OUTCOME MEASURES: Days waited from referral for surgery to surgery itself; socioeconomic status based on Carstairs index of deprivation. RESULTS: Mean and median waiting times rose initially and then fell steadily over time. By 2007 variation in waiting times across the population tended to be lower. In 1997 waiting times and deprivation tended to be positively related. By 2007 the relation between deprivation and waiting time was less pronounced, and, in some cases, patients from the most deprived fifth were waiting less time than patients from the most advantaged fifth. CONCLUSIONS: Between 1997 and 2007 waiting times for patients having elective hip replacement, knee replacement, and cataract repair in England went down and the variation in waiting times for those procedures across socioeconomic group...