Abstract
National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper argues that the search for an empirically based resource allocation formula of high precision in the name of promotion of equity is largely fruitless given the impossibility of measuring the true need for, and costs of, providing health care, especially with the limited data available. The inclusion of measures of social deprivation is also poorly thought out. The availability of data from the 1991 census, which included a question regarding long-standing illness, together with the intention of the Department of Health to review the weighted capitation formula using this information may stimulate much work but little light. It is essential that the impact of resource allocation formulas is justifiable on grounds other than the composition of any particular formula.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Balarajan R., Yuen P., Machin D. Socioeconomic differentials in the uptake of medical care in Great Britain. J Epidemiol Community Health. 1987 Sep;41(3):196–199. doi: 10.1136/jech.41.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ben-Shlomo Y., White I., McKeigue P. M. Prediction of general practice workload from census based social deprivation scores. J Epidemiol Community Health. 1992 Oct;46(5):532–536. doi: 10.1136/jech.46.5.532. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Blane D., Smith G. D., Bartley M. Social class differences in years of potential life lost: size, trends, and principal causes. BMJ. 1990 Sep 1;301(6749):429–432. doi: 10.1136/bmj.301.6749.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campbell D. A., Radford J. M., Burton P. Unemployment rates: an alternative to the Jarman index? BMJ. 1991 Sep 28;303(6805):750–755. doi: 10.1136/bmj.303.6805.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carr-Hill R. A., Maynard A., Slack R. Morbidity variation and RAWP. J Epidemiol Community Health. 1990 Dec;44(4):271–273. doi: 10.1136/jech.44.4.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carstairs V., Morris R. Deprivation, mortality and resource allocation. Community Med. 1989 Nov;11(4):364–372. [PubMed] [Google Scholar]
- Curtis S. E. Use of survey data and small area statistics to assess the link between individual morbidity and neighbourhood deprivation. J Epidemiol Community Health. 1990 Mar;44(1):62–68. doi: 10.1136/jech.44.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Frankel S. The epidemiology of indications. J Epidemiol Community Health. 1991 Dec;45(4):257–259. doi: 10.1136/jech.45.4.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fuchs V. R. "Though much is taken": reflections on aging, health, and medical care. Milbank Mem Fund Q Health Soc. 1984 Spring;62(2):143–166. [PubMed] [Google Scholar]
- Hart J. T. Two paths for medical practice. Lancet. 1992 Sep 26;340(8822):772–775. doi: 10.1016/0140-6736(92)92304-x. [DOI] [PubMed] [Google Scholar]
- Jessop E. G. Individual morbidity and neighbourhood deprivation in a non-metropolitan area. J Epidemiol Community Health. 1992 Oct;46(5):543–546. doi: 10.1136/jech.46.5.543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Knox E. G. Principles of allocation of health care resources. J Epidemiol Community Health. 1978 Mar;32(1):3–9. doi: 10.1136/jech.32.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leck I. The north-south divide in England: implications for health care resource allocation. Community Med. 1989 May;11(2):102–107. [PubMed] [Google Scholar]
- Livesley B. Running out of staff for the NHS. BMJ. 1989 Jul 1;299(6690):1–2. doi: 10.1136/bmj.299.6690.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Long A. F., Sheldon T. A. Enhancing effective and acceptable purchaser and provider decisions: overview and methods. Qual Health Care. 1992 Mar;1(1):74–76. doi: 10.1136/qshc.1.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lubitz J., Prihoda R. The use and costs of Medicare services in the last 2 years of life. Health Care Financ Rev. 1984 Spring;5(3):117–131. [PMC free article] [PubMed] [Google Scholar]
- Mays N. NHS resource allocation after the 1989 white paper: a critique of the research for the RAWP review. Community Med. 1989 Aug;11(3):173–186. doi: 10.1093/oxfordjournals.pubmed.a042466. [DOI] [PubMed] [Google Scholar]
- Morgan M., Mays N., Holland W. W. Can hospital use be a measure of need for health care? J Epidemiol Community Health. 1987 Dec;41(4):269–274. doi: 10.1136/jech.41.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morris R., Carstairs V. Which deprivation? A comparison of selected deprivation indexes. J Public Health Med. 1991 Nov;13(4):318–326. [PubMed] [Google Scholar]
- O'Donnell O., Propper C. Equity and the distribution of UK National Health Service resources. J Health Econ. 1991 May;10(1):1–19. doi: 10.1016/0167-6296(91)90014-e. [DOI] [PubMed] [Google Scholar]
- Palmer S., West P., Patrick D., Glynn M. Mortality indices in resource allocation. Community Med. 1979 Nov;1(4):275–281. doi: 10.1007/BF02549239. [DOI] [PubMed] [Google Scholar]
- Royston G. H., Hurst J. W., Lister E. G., Stewart P. A. Modelling the use of health services by populations of small areas to inform the allocation of central resources to larger regions. Socioecon Plann Sci. 1992 Jul;26(3):169–180. doi: 10.1016/0038-0121(92)90008-s. [DOI] [PubMed] [Google Scholar]
- Victor C. R. Health status of the temporarily homeless population and residents of North West Thames region. BMJ. 1992 Aug 15;305(6850):387–391. doi: 10.1136/bmj.305.6850.387. [DOI] [PMC free article] [PubMed] [Google Scholar]