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Lookup NU author(s): Graham Kirkwood, Professor Allyson PollockORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2025. This study analyzes National Health Service (NHS)-funded elective primary hip and knee replacement admissions and waiting times in England by provider (the NHS and private), socioeconomic deprivation and comorbidity, both prior to the introduction of Independent Sector Treatment Centers from 1997 to 2003 and following the rapid expansion in NHS contracts with the private sector from 2008 to 2019. Between 1997 and 2019, NHS-funded admission rates more than doubled. Between 2003 and 2008, when the proportion of patients treated in the private sector was negligible, admissions to the NHS increased and waiting times more than halved. After 2008, following the expansion in use of private providers by the NHS, NHS admission rates fell and waiting times rose for all patients. Waiting times for private providers were half those for the NHS, and the poorest 20 percent waited longer than the richest 20 percent. Between 2003 and 2019, inequalities in waiting time rose for the poorest 20 percent. The introduction of private providers into the NHS is associated with a contraction in in-house NHS provision, increasing waiting times for all patients and a two-tier system operating in favor of the rich.
Author(s): Kirkwood G, Pollock AM
Publication type: Article
Publication status: Published
Journal: International Journal of Social Determinants of Health and Health Services
Year: 2025
Volume: 55
Issue: 4
Pages: 455-464
Print publication date: 01/10/2025
Online publication date: 27/04/2025
Acceptance date: 02/04/2018
Date deposited: 23/05/2025
ISSN (print): 2755-1938
ISSN (electronic): 2755-1946
Publisher: SAGE Publications Inc.
URL: https://doi.org/10.1177/27551938251336949
DOI: 10.1177/27551938251336949
Data Access Statement: The datasets used for this study were made available to the researchers under a strict license from NHS Digital England and are not per- mitted to be made publicly available
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