Choosing and booking—and attending? Impact of an electronic booking system on outpatient referrals and non‐attendances

Dusheiko, Mark; Gravelle, Hugh

doi:10.1002/hec.3552

Cited by 21 publications

(21 citation statements)

References 34 publications

(22 reference statements)

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“…To complement the choice reforms, an electronic booking service for outpatient appointments was rolled out from 2005 to help patients and their GPs make a firm booking during a consultation (Dusheiko and Gravelle, 2018). Since 2007, the NHS Choices website has provided public information on services and quality of providers.…”

Section: Institutional Backgroundmentioning

confidence: 99%

Heterogeneous effects of patient choice and hospital competition on mortality

Moscelli¹,

Gravelle²,

Siciliani³

et al. 2018

Social Science & Medicine

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We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62% (95% CI: 1.22%, 0.01%), compared with the 2002/3-2010/11 mean of 3.5%, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3% of AMI patients and 21% of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions.

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Section: Institutional Backgroundmentioning

confidence: 99%

Heterogeneous effects of patient choice and hospital competition on mortality

Moscelli¹,

Gravelle²,

Siciliani³

et al. 2018

Social Science & Medicine

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“… 11 One of the most recent studies reports that flexible booking systems, where the patient is offered a choice between all available time slots in an online booking system, could further reduce non-attendance. 12 While these areas of research are ongoing, both reminders and flexible bookings have been widely implemented, but non-attendance appears to remain an issue.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics

2018

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Objectives Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. Design, participants and setting 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. Intervention A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. Main outcome measures The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. Results All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI –9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. Conclusions At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. Trial registration number NCT61925912

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“…Studies to date suggest that quality has improved for some conditions (Cooper, Gibbons, Jones, & Mcguire, ; Gaynor et al, ; Gravelle et al, ; Moscelli, Gravelle, Siciliani, & Santos, ), but may have fallen for others (Moscelli, Gravelle, & Siciliani, ; Skellern, ). Account must also be taken of the direct costs of implementing the policy change, such as some proportion of the £280m spent by the NHS up to 2012 to set‐up and run the electronic “Choose and Book” system to facilitate patients' participation in their hospital referrals (Department of Health, , Dusheiko & Gravelle, ). There are also other potentially welfare‐increasing policy tools available, such as direct financial incentives for providers (Meacock, Kristensen, & Sutton, ), regulation, targets (Propper et al, ), and organisational and budgetary changes (Mason, Goddard, Weatherly, & Chalkley, ; Siciliani, Chalkley, & Gravelle, ), which can be used as substitutes or complements to changes in competition among providers.…”

Section: Discussionmentioning

confidence: 99%

Does hospital competition improve efficiency? The effect of the patient choice reform in England

et al. 2019

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We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences‐in‐differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/2003 to 2010/2011. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%.

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Choosing and booking—and attending? Impact of an electronic booking system on outpatient referrals and non‐attendances

Cited by 21 publications

References 34 publications

Heterogeneous effects of patient choice and hospital competition on mortality

Heterogeneous effects of patient choice and hospital competition on mortality

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics

Does hospital competition improve efficiency? The effect of the patient choice reform in England

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