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Feature Data Briefing

Hip replacements: do public or private providers do better?

BMJ 2020; 368 doi: (Published 19 February 2020) Cite this as: BMJ 2020;368:m362
  1. John Appleby, director of research and chief economist
  1. Nuffield Trust, London, UK
  1. john.appleby{at}

There really isn’t much difference between NHS and non-NHS hospitals in outcomes of this surgery, concludes John Appleby

Hip replacements are a pretty successful operation, patients think. Nearly 90% who had one and who completed usable patient reported outcome measure (PROM) questionnaires in 2018-19 (around 25 000 questionnaires from around 175 000 eligible procedures) reported an improvement in their general health, for example.1 These operations are, on average, cost effective too.2

But this headline finding conceals variation among hospitals and patients in England.

One measure of health outcomes is the generic EQ-5D, used across a wide range of conditions and settings. (Other measures for outcomes from hip operations include the Oxford hip score.) The EQ-5D questionnaire, completed by patients before and after an operation, records their level of mobility, pain, anxiety or depression, self care, and usual activities. Scores on these individual dimensions can be compressed into …

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