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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引用次数: 0

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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推动医院间竞争的经济政策如何影响医疗质量：以英国国民保健服务体系为例（系统回顾）

英国国家医疗服务体系（NHS）经历了重大改革，包括20世纪90年代的内部市场改革和2006年的患者选择改革。本系统综述考察了推动医院竞争的经济政策如何影响护理质量，特别是手术结果，使用可及性和有效性作为指标。方法本系统评价遵循PRISMA指南。研究从四个数据库（Embase、Global Health、HMIC和Medline）中确定，纳入标准侧重于竞争对NHS内外科护理的影响。结果308项研究中，12项符合纳入标准。竞争通常会提高手术质量，尽管质量衡量标准存在差异。结论NHS的竞争改善了手术效果，特别是在大容量手术中。这些发现与美国外科实践相关，在那里类似的竞争可能会提高效率和质量。然而，政策必须解决患者选择偏差和地区差异的风险，以确保外科专科的公平改进。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.