Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7

We examine whether hospital patients living in low income areas of England cost more to treat, using elective hip replacement as a tracer procedure and length of stay as a cost indicator. Anonymous hospital records are extracted on all 235,813 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2006/7. The relationship between length of stay and small area income deprivation is modelled using linear regression, allowing for patient characteristics (age, sex, number of diagnoses, procedure type), time trends and Trust effects. Patients from the most income deprived decile of areas stay 12-15% longer than those from the least deprived decile, or 8% longer after adjusting for patient characteristics and Trust effects. This relationship did not change during the period, despite substantial NHS expenditure growth and reform along with substantial declines in average length of stay and waiting time. The major determinants of length of stay are age and number of diagnoses. Under the current NHS fixed price payment system, there are incentives for hospitals to avoid offering hip replacements to elderly patients, patients with substantial co-morbidity and, to a lesser extent, patients from low income areas.Health Care Economics and Organizations, Hospital Costs, Length of Stay, Prospective Payment System, Socioeconomic Factors