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What are the Costs and Benefits of Providing Comprehensive Seven‐day Services for Emergency Hospital Admissions?

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  • Rachel Meacock
  • Tim Doran
  • Matt Sutton

Abstract

The English National Health Service is moving towards providing comprehensive 7‐day hospital services in response to higher death rates for emergency weekend admissions. Using Hospital Episode Statistics between 1st April 2010 and 31st March 2011 linked to all‐cause mortality within 30 days of admission, we estimate the number of excess deaths and the loss in quality‐adjusted life years associated with emergency weekend admissions. The crude 30‐day mortality rate was 3.70% for weekday admissions and 4.05% for weekend admissions. The excess weekend death rate equates to 4355 (risk adjusted 5353) additional deaths each year. The health gain of avoiding these deaths would be 29 727–36 539 quality‐adjusted life years per year. The estimated cost of implementing 7‐day services is £1.07–£1.43 bn, which exceeds by £339–£831 m the maximum spend based on the National Institute for Health and Care Excellence threshold of £595 m–£731 m. There is as yet no clear evidence that 7‐day services will reduce weekend deaths or can be achieved without increasing weekday deaths. The planned cost of implementing 7‐day services greatly exceeds the maximum amount that the National Health Service should spend on eradicating the weekend effect based on current evidence. Policy makers and service providers should focus on identifying specific service extensions for which cost‐effectiveness can be demonstrated. Copyright © 2015 John Wiley & Sons, Ltd.

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  • Rachel Meacock & Tim Doran & Matt Sutton, 2015. "What are the Costs and Benefits of Providing Comprehensive Seven‐day Services for Emergency Hospital Admissions?," Health Economics, John Wiley & Sons, Ltd., vol. 24(8), pages 907-912, August.
    • Handle: RePEc:wly:hlthec:v:24:y:2015:i:8:p:907-912
    DOI: 10.1002/hec.3207
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    References listed on IDEAS

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    1. Rachel Meacock & Søren Rud Kristensen & Matt Sutton, 2014. "The Cost‐Effectiveness Of Using Financial Incentives To Improve Provider Quality: A Framework And Application," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 1-13, January.
    2. Rachael Maree Hunter & Charles Davie & Anthony Rudd & Alan Thompson & Hilary Walker & Neil Thomson & James Mountford & Lee Schwamm & John Deanfield & Kerry Thompson & Bikash Dewan & Minesh Mistry & Sa, 2013. "Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
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    1. Fermi problems and public health
      by Sam Watson in The Academic Health Economists' Blog on 2016-03-17 13:00:40

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    Cited by:

    1. Livio Garattini & Alessandro Curto & Nick Freemantle, 2016. "Access to primary care in Italy: time for a shake-up?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(2), pages 113-116, March.
    2. Martin, Stephen & Street, Andrew & Han, Lu & Hutton, John, 2016. "Have hospital readmissions increased in the face of reductions in length of stay? Evidence from England," Health Policy, Elsevier, vol. 120(1), pages 89-99.
    3. Florian Bachner & Martin Zuba, 2022. "The weekend effect in stroke mortality: evidence from Austrian acute care hospitals," International Journal of Health Economics and Management, Springer, vol. 22(2), pages 205-236, June.
    4. Krämer, Jonas & Schreyögg, Jonas, 2019. "Substituting emergency services: primary care vs. hospital care," Health Policy, Elsevier, vol. 123(11), pages 1053-1060.
    5. Underwood, Charlotte & Sutton, Matt & Meacock, Rachel, 2019. "Association between elevated weekend mortality and the seven-day hospital services programme in England: A retrospective longitudinal study," Health Policy, Elsevier, vol. 123(11), pages 1042-1048.
    6. Jonas Krämer & Jonas Schreyögg & Reinhard Busse, 2019. "Classification of hospital admissions into emergency and elective care: a machine learning approach," Health Care Management Science, Springer, vol. 22(1), pages 85-105, March.

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