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Cancelled Surgeries and Perverse Incentives in the English National Health Service

McIntosh, B, Cookson, GD and Jones, S (2012) Cancelled Surgeries and Perverse Incentives in the English National Health Service Journal of Health Services Research and Policy, 2. pp. 79-86.

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Abstract

Objectives To model the frequency of ‘last minute’ cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. Methods A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22 – ‘Planned elective procedure not carried out’ – was modeled using a probit regession estimated via maximum likelihood including patient, case and hospital level covariates. Results Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socio-economic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. Conclusions Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socio-economic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > Surrey Business School
Authors :
AuthorsEmailORCID
McIntosh, BUNSPECIFIEDUNSPECIFIED
Cookson, GDUNSPECIFIEDUNSPECIFIED
Jones, SUNSPECIFIEDUNSPECIFIED
Date : 1 April 2012
Identification Number : https://doi.org/10.1258/jhsrp.2011.011053
Related URLs :
Additional Information : Jones, S and McIntosh, B (2012) Cancelled Surgeries and Perverse Incentives in the English National Health Service Journal of Health Services Research and Policy, 2 . 79 - 86. ISSN 1355-8196 DOI: 10.1258/jhsrp.2011.011053 This is the final draft, after peer-review, of a manuscript published in RSM journals: www.rsmpress.com.
Depositing User : Symplectic Elements
Date Deposited : 28 Mar 2017 14:09
Last Modified : 28 Mar 2017 14:09
URI: http://epubs.surrey.ac.uk/id/eprint/722289

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