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• Overall waiting times fell but less so in hospitals facing more pre-reform competition • Hip and knee replacement patients in hospitals with more rivals faced higher waits • Waiting time variation within small geographical areas increased with competition • Competition had a pro-poor effect on the concentration of waiting times by SES deprivation • Healthcare competition can have unintended effects like longer, more dispersed waits We use a quasi difference-in-difference approach to examine whether the 2006 relaxation of constraints on patient choice of hospital in the English National Health Service (NHS) affected waiting times inequalities for three common elective treatments (coronary bypass, hip replacement and knee replacement) in hospitals which faced more potential competition (number of rivals) before the choice reform was introduced relative to those which faced less competition. After the 2006 choice reform hospitals which had more rivals before 2006 had longer waits for hip and knee replacement, with one additional rival increasing the median waiting time by 2.5% and 4.0%, and the 75th quantile waiting time by 4.2% and 7.1%. There was no effect on waiting times for coronary bypass patients up to the 75th quantile of the wait distribution. The choice reform and market structure had no effect on the standard deviation of waiting times within hospitals but did increase waiting time variation within small geographical areas. Older hip replacement patients had shorter waits pre-choice reform but the gradient disappeared after it and was not affected by market structure. Before the choice reform, more deprived patients had longer waits but post-reform there was no deprivation gradient in waiting times, and the reduction in the gradient was not affected by pre-reform market structure. Overall, the results suggest that the choice reform led to longer and more dispersed waiting times in more competitive areas but deprivation related inequity was smaller in the post-choice period. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care. Methods: A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014–January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013–2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics. Results: 12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found. Conclusions: Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out. [ABSTRACT FROM AUTHOR]

Background: We undertook a prospective qualitative survey to ascertain the perceptions and experience of National Health Service patients in the United Kingdom who underwent planned or elective procedures and surgery at alternate 'clean' hospital sites during the coronavirus disease 2019 (COVID-19) pandemic. These alternate 'clean' hospital sites were independent hospitals running active staff and patient testing programmes for COVID-19 and which did not admit or treat patients suffering with COVID-19. Methods: A prospective survey was undertaken to include patients at least 30 days after a planned surgery or procedure conducted at a 'clean' alternate hospital site during the COVID-19 pandemic. The study was conducted using structured interviews undertaken by trained assessors. A 20% sample group of patients were randomly selected to participate in this study. Qualitative data related to confidence, safety and perceptions of safety were collected. Results: Ninety-five patients (60%) reported that they had prior worries or concerns about undergoing an elective procedure during the COVID-19 pandemic. A total of 47 patients (30%) had delayed their surgery at least once because of these concerns. A total of 150 patients (95%) felt that the precautions in place to protect their safety in the setting of an alternate 'clean' hospital site were well thought out and proportionate. Patients reported high levels of confidence in the measures undertaken. Separation of patient pathways using the independent sector and patient testing were identified by patients as having the greatest impact on their perception of safety. Conclusions: Patient confidence will be key to ensuring uptake of planned and elective procedures and surgery during the COVID-19 pandemic. Perceptions of safety will be key to this confidence and efforts to demonstrably enhance safety are well received by patients. In particular, patients felt that a dedicated programme of patient testing and separation of patient pathways provided the greatest levels of confidence in the safety of their treatment. [ABSTRACT FROM AUTHOR]