Variation in Processes of Care for Total Hip Arthroplasty across High-Income Countries

Total Hip Arthroplasty (THA) is among the most commonly performed elective surgeries in high-income countries, and wait times for THA have frequently been cited by US commentators as evidence that countries with universal insurance programs or national health systems “ration” care. This novel qualitative study explores processes of care for hip replacement in the US and six high-income countries with a focus on eligibility, wait-times, decision-making, post-operative care, and payment policies. We find no evidence of rationing or government interference in decision-making across high-income countries. Compared to the six other high-income countries in our study, the US has developed efficient care processes that often allow for a same-day discharge. In contrast, THA patients in Germany stay in the hospital 7-9 days and receive 2-3 weeks of inpatient rehabilitation. However, the payment per THA in the US remain far above other countries, despite far fewer inpatient days.