In a column written for the Healthcare Markets Magazine, PHINs strategic projects lead, Greg Swarbrick, looks at what the past seven years of PHIN data tells us about private patient demographics in UK in-patient and day surgery care.

We wanted to look at the demographics of patients having private in-patient or day surgery care over the years since PHIN began collecting data up to the latest available information (2016-22), as well as developments in the market since the Covid-19 pandemic began.

The PHIN article in April’s Healthcare Markets addressed the procedures patients received privately, so here I’ve focused on three key aspects of demographics: location, age and gender. Patient numbers are rounded to the nearest 5k for national level figures and nearest 5 for local level information. To make like-for-like comparisons over time, only hospitals that have consistently supplied PHIN with admitted patient care (APC) data throughout the period of the analysis have been included. Thus, absolute numbers do not describe the true size of the market, but the percentage changes more accurately reflect real organic growth or contraction.*

Based on the analysed data from these private hospitals over this time period, what we see is c. 695k private patient admissions in 2022, versus the previous high before Covid in 2019 of 650k and the lowest level over this timeframe of 625k in 2016.

Where are the procedures happening?

London is traditionally the heart of the UK’s independent healthcare sector, and its share of private treatment was at its highest (31% of UK admissions) in 2020, the year most impacted by the Covid pandemics and lockdowns. Since then, although the number of private procedures happening increased, its share reduced to 26% in both 2021 and 2022. This represents its lowest share of national activity in the years covered. It has not yet fully recovered since Covid, with 185k patients treated in 2022 versus 190k in 2019.

In the remaining regions, the South East (20%) and East of England (12%) provided the most private in-patient and day surgery treatment during the 2016-2022 period, with the other regions each with diminishingly smaller shares.

All nations/regions, except London, now have more private patients than in pre-Covid 2019, with the majority experiencing double digit growth, led by Wales (53%) and Scotland (20%). It should be noted that patient counts remain comparatively small versus London, the South East and East of England in the areas with the highest growth.

All regions were negatively impacted by Covid if we compare 2020 versus 2019, though there was some variance between regions, for example London (-29%) was less affected than the North-East (-41%).

Who are the patients?

By age:
The private patients age group (by 10-year grouping) that has grown the most over the past six years is 70 to 79-year-olds. This group is up 18% in 2022 versus pre-pandemic 2019 and up 35% in 2022 versus 2016.

The other age group seeing high increases is 80 to 89. There was a 25% overall increase between 2016 and 2022 for this demographic.

By contrast, there has been a decline for the 0 to 9 (-5%), 20 to 29 (-2%) and 90 to 99 (-8%) age groups when comparing 2022 to 2016.

Overall comparing 2020 with 2019 to have a sense of the impact of Covid by age group, the age groups seeing the greatest declines in treated private patient numbers were at either extreme of the lifespan: 0 to 9-years-old and 10 to 19 (both -38%) and the 90 to 99-years-old (-47%), with reductions occurring for both genders.

By gender**:
Over the past six full years, the gender split has remained robustly consistent, with on average 52% of private patients being female and 48% being male.

Male private patients outnumber females only in the 0 to 9 and 10 to 19 age groups. Thereafter, women outnumber men absolutely in the 30 to 39 (at 62% of the private treatment share for that decade), 40 to 49 (61%) and 20 to 29 (59%) age groups.

After this there is much closer parity between the genders. This only seems to confirm the notion that women are more likely to need, or perhaps more importantly to seek, treatments in their 20s, 30s, 40s and 50s: or else that men’s significant health needs occur later on in life, or that these are postponed and only addressed then.

There was no significant discrepancy in terms of the effect of treatments by gender as impacted by Covid. In 2020, private procedures were down at very similar levels (-32% for men and -34% for women).

Age, region and gender:
In 2022, London had by far the greatest share of the 0 to 9 and to a lesser degree the 10 to 19-year-old markets. For other 10-year age groups, the share is less pronounced. For those in their 90s and above, the South-East overtakes London in terms of number of private patients treated.

As an example of this regional contrast there were 3,345 boys receiving private in-patient or day surgery treatment in London in 2022 aged under 10, whereas in the North-East of England, the equivalent number was 0.

One thing to note is that another important aspect of demographics, ethnicity, is very incompletely coded in private healthcare. In the data submitted to PHIN, most hospitals list all their non-white patients in the ‘Other ethnic groups’ category, if at all. 

Previous analysis has shown that annually there are many thousands of patients treated privately in the UK who are in Asian, Black, mixed or other groups. We would encourage all hospitals and teams to improve the completeness, specificity, and accuracy of their ethnicity data, so we can give better insights, and help identify any implications of ethnicity on treatments and outcomes, in future.

Improving transparency

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* It should also be noted that, because of this approach, no hospitals from Northern Ireland feature in this analysis.
** Gender as recorded by hospitals 

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