Content area
Full text
About the Authors:
James A. Lopez Bernal
Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Writing - original draft, Writing - review & editing
* E-mail: [email protected]
Affiliations Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
ORCID http://orcid.org/0000-0002-1301-5653
Christine Y. Lu
Roles Investigation, Methodology, Writing - review & editing
Affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
Antonio Gasparrini
Roles Conceptualization, Investigation, Methodology, Supervision, Writing - review & editing
Affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
ORCID http://orcid.org/0000-0002-2271-3568
Steven Cummins
Roles Conceptualization, Investigation, Methodology, Supervision, Writing - review & editing
Affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
ORCID http://orcid.org/0000-0002-3957-4357
J. Frank Wharham
Roles Investigation, Methodology, Writing - review & editing
Affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
Steven B. Soumerai
Roles Conceptualization, Investigation, Methodology, Supervision, Validation, Writing - review & editing
Affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of AmericaAbstract
Background
The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissioning Groups (CCGs). An expected outcome was that patient care would shift away from expensive hospital and specialist settings, towards less expensive community-based models. However, there is little evidence for the effectiveness of this approach. In this study, we aimed to assess the association between the NHS reforms and hospital admissions and outpatient specialist visits.
Methods and findings
We conducted a controlled interrupted time series analysis to examine rates of outpatient specialist visits and inpatient hospitalisations before and after the implementation of the HSCA. We used national routine hospital administrative data (Hospital Episode Statistics) on all...