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The impact of private sector provision on equitable utilisation of coronary revascularisation
  1. Jennifer Mindell (jennym.epid{at}public-health.ucl.ac.uk)
  1. University College London, United Kingdom
    1. Ed Klodawski (eklodawski{at}lho.org.uk)
    1. London Health Observatory, United Kingdom
      1. Justine Fitzpatrick (jfitzpatrick{at}lho.org.uk)
      1. London Health Observatory, United Kingdom
        1. Neeraj Malhotra (nmalhotra{at}lho.org.uk)
        1. London Health Observatory, United Kingdom
          1. Martin McKee (martin.mckee{at}lshtm.ac.uk)
          1. London School of Hygiene & Tropical Medicine, United Kingdom
            1. Colin Sanderson
            1. London School of Hygiene & Tropical Medicine, United Kingdom

              Abstract

              Objective To investigate the impact of including private sector data on assessments of equity of coronary revascularisation provision using NHS data only.

              Design Analyses of Hospital Episodes Statistics and private sector data by age, sex, and PCT of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. GINI coefficients were derived to provide an index of inequality across sub-populations, with parametric bootstrapping to estimate confidence intervals.

              Setting London Participants London residents undergoing coronary revascularisation April 2001 - December 2003. Intervention Coronary artery bypass graft or angioplasty

              Main outcome measures Directly-standardised revascularisation rates, GINI coefficients.

              Results NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p=0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately-funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS funded care alone.

              Conclusion Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place.

              • Equity
              • NHS
              • Private sector
              • Revascularisation

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