How economic policies which drive competition amongst hospitals impacts quality of care: The case of the English NHS (A systematic review)

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-10 DOI:10.1016/j.amjsurg.2025.116237

Diego Najera Saltos, Søren Rud Kristensen

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Abstract

Background

England's National Health Service (NHS) has undergone significant reforms, including the internal market in the 1990s and the 2006 patient choice reform. This systematic review examines how economic policies driving hospital competition impact the quality of care, particularly surgical outcomes, using access and effectiveness as indicators.

Methods

This systematic review followed PRISMA guidelines. Studies were identified from four databases (Embase, Global Health, HMIC, and Medline) with inclusion criteria focusing on competition's effect on surgical care within the NHS.

Results

From 308 studies screened, 12 met the inclusion criteria. Competition generally improves surgical quality, though variations exist across quality measures.

Conclusion

Competition in the NHS has improved surgical outcomes, especially in high-volume procedures. These findings are relevant to US surgical practice, where similar competition may drive efficiency and quality. However, policies must address risks of patient selection biases and regional disparities to ensure equitable improvements across surgical specialities.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.