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Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7

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  • Cookson R
  • Laudicella M

Abstract

We examine whether hospital patients living in low income areas of England cost more to treat, using elective hip replacement as a tracer procedure and length of stay as a cost indicator. Anonymous hospital records are extracted on all 235,813 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2006/7. The relationship between length of stay and small area income deprivation is modelled using linear regression, allowing for patient characteristics (age, sex, number of diagnoses, procedure type), time trends and Trust effects. Patients from the most income deprived decile of areas stay 12-15% longer than those from the least deprived decile, or 8% longer after adjusting for patient characteristics and Trust effects. This relationship did not change during the period, despite substantial NHS expenditure growth and reform along with substantial declines in average length of stay and waiting time. The major determinants of length of stay are age and number of diagnoses. Under the current NHS fixed price payment system, there are incentives for hospitals to avoid offering hip replacements to elderly patients, patients with substantial co-morbidity and, to a lesser extent, patients from low income areas.

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  • Cookson R & Laudicella M, 2009. "Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7," Health, Econometrics and Data Group (HEDG) Working Papers 09/07, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:09/07
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    1. Hamilton, Barton H & Bramley-Harker, Robert Edward, 1999. "The Impact of the NHS Reforms on Queues and Surgical Outcomes in England: Evidence from Hip Fracture Patients," Economic Journal, Royal Economic Society, vol. 109(457), pages 437-462, July.
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    1. Oddvar Kaarboe & Fredrik Carlsen, 2014. "Waiting Times And Socioeconomic Status. Evidence From Norway," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 93-107, January.
    2. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    3. James Gaughan & Hugh Gravelle & Rita Santos & Luigi Siciliani, 2013. "Long term care provision, hospital length of stay and discharge destination for hip fracture and stroke patients," Working Papers 086cherp, Centre for Health Economics, University of York.
    4. James Gaughan & Hugh Gravelle & Rita Santos & Luigi Siciliani, 2017. "Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 311-331, September.
    5. Claudia Geue & James Lewsey & Paula Lorgelly & Lindsay Govan & Carole Hart & Andrew Briggs, 2012. "Spoilt For Choice: Implications Of Using Alternative Methods Of Costing Hospital Episode Statistics," Health Economics, John Wiley & Sons, Ltd., vol. 21(10), pages 1201-1216, October.

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    Keywords

    Health Care Economics and Organizations; Hospital Costs; Length of Stay; Prospective Payment System; Socioeconomic Factors;
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