Does increased use of private health care reduce the demand for NHS care? A prospective survey of general practice referrals.

Publisher: Oxford University Press Country of Publication: England NLM ID: 101188638 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1741-3842 (Print) Linking ISSN: 17413842 NLM ISO Abbreviation: J Public Health (Oxf) Subsets: MEDLINE

Original Publication: Oxford, UK : Oxford University Press, c2004-

Specialization*; Family Practice/*statistics & numerical data ; Hospitals, Private/*statistics & numerical data ; Hospitals, Public/*statistics & numerical data ; Medicine/*organization & administration ; Practice Patterns, Physicians'/*statistics & numerical data ; Private Practice/*statistics & numerical data ; Referral and Consultation/*statistics & numerical data ; State Medicine/*statistics & numerical data ; Vulnerable Populations/*statistics & numerical data; Adolescent ; Adult ; Aged ; Catchment Area, Health ; Child ; Child, Preschool ; Computer Systems ; Confidence Intervals ; England ; Female ; Health Care Surveys/methods ; Health Services Needs and Demand/trends ; Humans ; Infant ; Infant, Newborn ; Male ; Medicine/classification ; Medicine/statistics & numerical data ; Middle Aged ; Odds Ratio ; Referral and Consultation/classification

Background: The use of the private sector for health care is increasing, but it is unclear whether this will reduce demand on the NHS. The aim of this study was to examine the relationship between private and NHS outpatient referral rates accounting for their association with deprivation.
Methods: This is a prospective survey of general practitioner referrals to private and NHS consultant-led services between 1 January and 31 December 2001 from 10 general practices in the Trent Focus Collaborative Research Network, United Kingdom. Patient referrals were aggregated to give private and NHS referral rates for each electoral ward in each practice.
Results: Of 17,137 referrals, 90.4 percent (15,495) were to the NHS and 9.6 percent (1642) to the private sector. Private referral rates were lower in patients from the most deprived fifth of wards compared with the least deprived fifth (rate ratio 0.25, 95 percent CI 0.15 to 0.41, p < 0.001), whereas NHS referral rates were slightly higher in patients in the most deprived fifth of wards (rate ratio 1.18, 95 percent CI 0.98 to 1.42, p = 0.08) both after age standardisation and adjustment for practice. The NHS referral rate was significantly higher (rate ratio 1.40, 95 percent CI 1.15 to 1.71, p = 0.001) in wards with private referral rates in the top fifth compared with the bottom fifth after adjustment for deprivation and practice.
Conclusions: Increased private health care activity does not reduce the demand for NHS care: NHS and private referral rates were positively associated with each other after adjusting for age, deprivation and practice.

Date Created: 20050319 Date Completed: 20051020 Latest Revision: 20191210

20221213

10.1093/pubmed/fdi013

15774570