Abstract：
Parliament has imposed duties on the government and NHS in England aimed at reducing health inequalities. AIM: to understand the effect on inequalities of government policies, which require the NHS in England to outsource elective surgery to the private sector. We analysed the numbers of admissions for hip and knee replacement surgery from the least and most deprived population quintiles in three time periods: before the introduction of the policies (1997/98-2002/03); following the implementation of the independent sector treatment centre programme (2003/04-2006/07); and after the extension of \'choice at referral\' (2007/08-2018/19). RESULTS: despite admission rates doubling and trebling for hip and knee replacements, respectively, between 1997/98 and 2018/19, inequality grew to the detriment of the most deprived. Inequality grew at the fastest rate during period 3; admission rates to the NHS fell while admissions to the private sector continued to rise. By 2018/19 almost a third of NHS funded procedures were provided privately. In 1997/98, for every 10 patients admitted for hip and knee surgery from the most deprived quintile, 13 and 9, respectively were admitted from the least deprived, by 2018/19 the gap had widened to 19 and 15, respectively. Socio-economic inequalities for hip and knee replacement have widened as outsourcing of NHS treatment to the private sector has increased. The NHS must rebuild in-house capacity and provision instead of outsourcing care.
摘要：
议会已对英国政府和NHS征收关税，旨在减少健康不平等。目的：了解政府政策对不平等的影响，这要求英国的NHS将择期手术外包给私营部门。我们分析了三个时间段内最少和最贫困的五分之一人群中髋关节和膝关节置换手术的入院人数：政策出台前（1997/98-2002/03）；独立部门治疗中心计划实施后（2003/04-2006/07）；以及“转诊时的选择”延长后（2007/08-2018/19）。结果：尽管髋关节和膝关节置换的入院率增加了一倍和两倍，分别,在1997/98年至2018/19年期间，不平等现象加剧，损害了最贫困的人群。在第3期，不平等以最快的速度增长；NHS的录取率下降，而私营部门的录取率继续上升。到2018/19年度，近三分之一的NHS资助程序是私下提供的。在1997/98年，每10名最贫困的五分之一人中就有10名接受髋关节和膝关节手术的患者，13和9，分别从最不被剥夺的人那里被接纳，到2018/19年，差距分别扩大到19和15。随着NHS治疗外包给私营部门的增加，髋关节和膝关节置换的社会经济不平等现象已经扩大。NHS必须重建内部能力和供应，而不是外包护理。
