Hamilton B & Bramley-Harker R (1999)

‘The Impact of the NHS Reforms on Queues and Surgical Outcomes in England: Evidence From Hip Fracture Patients’

Economic Journal 109 pp. 437-462

• Empirical examination of the effect of the internal market on waiting times, and the effect of waiting times on patient outcomes.
• Uses NHS data on hip fracture patients from 1990/1 to 1994/5.

Key results:

• Waiting times for surgery fell significantly after the reforms, while outcomes such as length of stay improved.
• These changes occurred immediately after the introduction of the reforms, despite the fact that there was no technical change in hip fracture surgical methods and no evidence of ‘learning effects’ for the procedure.
• However, the authors find little evidence that surgical delay has a substantial effect on post-surgical outcomes – a surprising result at odds with some previous literature.
• The authors have no direct evidence regarding quality of care, but they find that the conditional probability of inpatient mortality declined slightly between 1990/1 and 1994/5.

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