A study just published on bmj.com reports that recent NHS reforms, such as the introduction of patient choice and provider competition, have not had a harmful impact on equity with respect to waiting times for elective surgery in England.

For the NHS, hospital waiting times were seen as a considerable problem until recently. However, waiting times have dropped considerably since the government over the past ten years increased the supply of doctors, augmented funding for the health service, set rigid waiting time targets, and, more recently, introduced market based reforms.

Until now, it was unclear whether the drop in waiting times had been equitably distributed with respect to socioeconomic status.

In order to find out more, a team of researchers led by Zack Cooper and Julian Le Grand of the London School of Economics & Political Science, examined changes in waiting times. The patients in the evaluation were undergoing three key elective procedures in England between 1997 and 2007: hip replacement, knee replacement and cataract repair. The distribution of the variations between socioeconomic groups was then analyzed.

Waiting times were measured as days waited from referral for surgery to surgery itself. Results were then related to patient postcodes. Socioeconomic status was calculated using a recognized index of deprivation.

Results indicated that average waiting times rose initially and then fell steadily over time. By 2007, there was far less disparity in waiting times across the population.

In 1997, individuals from more deprived areas waited longer for treatment than those from more affluent areas. But, by 2007, this phenomenon had disappeared. Actually, in some cases, patients from more deprived areas were waiting less time than patients from more affluent areas.

Many feared that the government’s NHS reforms would lead to inequality or injustice. However, these findings demonstrate that inequity with respect to waiting times did not increase. In reality, if anything, it substantially decreased.

The authors explain: “While these findings cannot prove what policy mechanisms led to reductions in waiting times and improvements in equity, they do confirm that these reforms did not lead to the inequitable distribution of waiting times across socioeconomic groups that many had predicted.”

While the government continues to put emphasis on the importance of choice and competition, these findings should be integrated into the debate on whether these reforms will essentially lead to greater equity or inequity.

“Equity, waiting times, and NHS reforms: retrospective study”
Zachary N Cooper, PhD candidate in public policy, Alistair McGuire, professor of health economics, S Jones, chief statistician, J Le Grand, Richard Titmuss professor of social policy
BMJ 2009; 339:b3264
bmj.com

Written by Stephanie Brunner (B.A.)