Our Summary

After healthcare responsibilities were devolved to England and Scotland in 1999, they each adopted different methods of hospital payment. England started paying per case from 2003/4 while Scotland continued to pay in lump sums. This study explores how this change affected the treatment of hip replacements. In England, the payment for non-cemented hip replacements was more than cemented ones, even though national clinical guidelines recommended the latter. This price difference didn’t exist in Scotland. The researchers compared the situations in both countries to see if the payment methods influenced treatment decisions. They found that the higher payments in England led to a quicker adoption of the more expensive non-cemented hip replacements, despite clinical guidelines recommending otherwise. This suggests that financial incentives directly influenced treatment choices.

FAQs

  1. What different hospital payment methods did England and Scotland adopt after the devolution of healthcare responsibilities in 1999?
  2. Did the payment methods in England and Scotland influence the treatment decisions for hip replacements?
  3. Why was the payment for non-cemented hip replacements in England more than cemented ones, despite the national clinical guidelines recommending the latter?

Doctor’s Tip

A helpful tip a doctor might give a patient about hip replacement surgery is to follow post-operative instructions carefully, including physical therapy exercises and restrictions on certain activities. This will help ensure a successful recovery and long-term success of the hip replacement. Additionally, maintaining a healthy weight and staying active can also help prolong the life of the artificial hip joint.

Suitable For

Patients who are recommended for hip replacement surgery typically have severe hip pain that interferes with daily activities, have not found relief with other non-surgical treatments, have arthritis or other hip conditions that have caused significant damage to the hip joint, have difficulty walking or performing other movements due to hip pain, and have a decreased quality of life due to hip pain. Additionally, patients who are generally healthy and able to tolerate surgery and rehabilitation are also good candidates for hip replacement.

Timeline

  • Patient experiences hip pain and limited mobility, leading to a consultation with a healthcare provider
  • Healthcare provider recommends hip replacement surgery as the best course of treatment
  • Patient undergoes pre-operative evaluations and testing to ensure they are a suitable candidate for surgery
  • Surgery is scheduled and performed, with the patient receiving anesthesia and the damaged hip joint being replaced with a prosthetic implant
  • Patient spends a few days in the hospital for recovery and rehabilitation, with physical therapy sessions to help regain strength and mobility
  • Patient is discharged from the hospital and continues with at-home exercises and follow-up appointments with their healthcare provider
  • Over time, patient experiences improved mobility and reduced pain, allowing them to resume normal activities and enjoy a better quality of life

What to Ask Your Doctor

  1. What are the different types of hip replacement options available, and which one do you recommend for me?

  2. What are the potential risks and complications associated with hip replacement surgery?

  3. What is the expected recovery time and rehabilitation process after hip replacement surgery?

  4. Will I need physical therapy after the surgery, and for how long?

  5. How long can I expect the hip replacement to last before needing a revision surgery?

  6. What are the success rates of hip replacement surgery, and what factors can affect the outcome?

  7. Are there any lifestyle changes or precautions I should take after hip replacement surgery?

  8. Will I need to take any medications or supplements before or after the surgery?

  9. How often will I need follow-up appointments after the surgery, and what should I expect during these visits?

  10. Are there any alternative treatments or non-surgical options that I should consider before opting for hip replacement surgery?

Reference

Authors: Papanicolas I, McGuire A. Journal: J Health Econ. 2015 Dec;44:25-36. doi: 10.1016/j.jhealeco.2015.08.001. Epub 2015 Aug 24. PMID: 26359587