Day Case Surgery Trends in England: The Influences of Target Setting and of General Practitioner Fundholding

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Abstract
Objectives: To describe the trends in the proportion of elective surgery carried out as day cases, and the impact of the setting of targets and the introduction of general practitioner (GP) fundholding on the use of day surgery. Methods: Cross-sectional analysis of Hospital Episode Statistics for England, 1990/1991 to 1994/1995, comparing procedures for which targets were and were not set, and comparing types of purchaser (GP fundholder and health authority). Results: Elective surgical procedures increased from 2.7 million in 1990/1991 to 3.9 million in 1994/1995, a 44% increase. Increased numbers of day cases (up 117%) accounted for almost all of the increased total activity. The proportion of day cases rose from 35% to 53% over the period. Those procedures for which targets were set (over 25% of elective surgery) had a slightly lower day case proportion in 1990/1991 (34% compared to 36%) but slightly higher by 1994/1995 (57% compared to 52%). GP fundholders generally had slightly lower proportions treated as day cases compared to health authorities. Conclusions: Day cases were additional to, rather than a substitute for, inpatient treatments. Setting day case targets may have been associated with growth in use of day surgery, but there was no association with type of purchaser.