Methods and resultsInformation on patients admitted as inpatients or day cases during sample periods in financial year 1997-8 were obtained from 215 of 221 acute independent hospitals with operating departments in England and Wales 2 ; data obtained included the patient's clinical status, demographic information, and source of funding for the procedure. Numbers for the whole year were estimated by weighting the sample data according to the duration of sampling, the time of year, and the number of hospitals that did not respond; these numbers were validated as previously described.3 Extracts of the latest data (for 1996-7) were obtained from the Department of Health and the Welsh Information Agency's hospital episodes statistics for waiting lists and scheduled admissions for NHS and private patients admitted for non-psychiatric, non-maternity care. Data for first consultant episodes (98% of all consultant episodes for elective patients and equivalent to the number of admissions) and data from independent hospitals were analysed using SPSS statistical software. Although these two sources of data were out of phase by a year, hospital episodes in the NHS for general and acute specialties rose only 2% between 1996-7 and 1997-8 (NHS Executive, personal communication, 1999.Altogether 739 810 of 5 094 404 patients (14.5%) had had private funding, and 591 755 of 4 415 334 surgical patients (13.4%) had had private funding (table). One in 10 private patients were treated in NHS hospitals, and 1% of NHS patients were treated in independent hospitals. Of the private admissions, 81% were funded by insurance and 18% were funded by the patient.
CommentThe proportion of elective treatments purchased privately has remained constant over nearly two decades. Although NHS patients and private patients receive a similar range of treatments the types of procedure differ proportionately. A higher than average proportion of patients pay for operations that relieve severe disability or discomfort-such as total replacement of the hip joint, which had a median NHS waiting time of 168 days in 1996-7, and lens operations for cataract (median waiting time 144 days)-and for those for which delay may increase the risk of dying, such as coronary artery operations (94 days).
Demand for short-stay independent hospital care is rising. The clientele is becoming older, and readier to pay out of pocket. Clinical activity is mainly surgical and similar to NHS elective surgical demand. One year's caseload equals 10 weeks' elective admissions to NHS hospitals, in that sense relieving the NHS. The scale of transfer to NHS hospitals (three per day) is small.
The feasibility of measuring exposure to extremely low frequency magnetic fields (ELF MF) in the UK Adult Brain Tumour Study (UKABTS) was examined. During the study, 81 individuals and 30 companies were approached with 79 individuals and 25 companies agreeing to participate. Exposure data were collected using EMDEX II dosemeters worn by the participants for 3-4 consecutive days. Data were collected over a total of 321 d, including non-occupational periods. The results showed occupational exposure to be the main determinant of overall exposure. Moderate to strong correlations were found between arithmetic mean exposure and all other metrics with the possible exception of maximum exposure. Significant differences in exposure were found between job categories with large variability in certain categories. Highest average exposures were found for security officers (arithmetic mean, AM: 0.78 micro T), secretaries (AM: 0.48 micro T) and dentists (AM: 0.42 micro T). Welding and working near high-voltage power lines were associated with elevated exposure. In summary, acceptably precise measures of ELF MF exposure are feasible at relatively moderate cost. The results were used to develop a protocol for data collection from subjects in the UKABTS.
This report substantially expands information on adult exposure to ELF MF in the UK. The accuracy of exposure assessments based solely on job codes is improved by linking with either industry code or contextual knowledge of equipment and of power lines or substations in the work environment.
Regionally, NHS resources and activity match need. Private hospital use complements lower levels of NHS service. Private consumption does not distort access according to need but in regions with lower levels of NHS activity those least deprived may make relatively more use of NHS hospitals, thus widening the health gap. Small area studies should explore this.
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