Abstract
Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance.
Key Words: Health economics • resource allocation • ethics of regional health care finance • capitation systems
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- Andersson P. A., Varde E., Diderichsen F. Modelling of resource allocation to health care authorities in Stockholm county. Health Care Manag Sci. 2000 Feb;3(2):141–149. doi: 10.1023/a:1019045408441. [DOI] [PubMed] [Google Scholar]
- Birch S., Abelson J. Is reasonable access what we want? Implications of, and challenges to, current Canadian policy on equity in health care. Int J Health Serv. 1993;23(4):629–653. doi: 10.2190/K18V-T33F-1VC4-14RM. [DOI] [PubMed] [Google Scholar]
- Campbell N. C., Elliott A. M., Sharp L., Ritchie L. D., Cassidy J., Little J. Rural factors and survival from cancer: analysis of Scottish cancer registrations. Br J Cancer. 2000 Jun;82(11):1863–1866. doi: 10.1054/bjoc.1999.1079. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carr-Hill R. A., Sheldon T. A., Smith P., Martin S., Peacock S., Hardman G. Allocating resources to health authorities: development of method for small area analysis of use of inpatient services. BMJ. 1994 Oct 22;309(6961):1046–1049. doi: 10.1136/bmj.309.6961.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Diderichsen F., Varde E., Whitehead M. Resource allocation to health authorities: the quest for an equitable formula in Britain and Sweden. BMJ. 1997 Oct 4;315(7112):875–878. doi: 10.1136/bmj.315.7112.875. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kluge E. H. The Canadian health care system. An analytical perspective. Health Care Anal. 1999;7(4):377–391. doi: 10.1023/A:1009408008379. [DOI] [PubMed] [Google Scholar]
- Mooney G. And now for vertical equity? Some concerns arising from aboriginal health in Australia. Health Econ. 1996 Mar-Apr;5(2):99–103. doi: 10.1002/(SICI)1099-1050(199603)5:2<99::AID-HEC193>3.0.CO;2-N. [DOI] [PubMed] [Google Scholar]
- Rice N., Smith P. C. Capitation and risk adjustment in health care financing: an international progress report. Milbank Q. 2001;79(1):81–VI. doi: 10.1111/1468-0009.00197. [DOI] [PMC free article] [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]
- Sheldon T. A., Smith P. C. Equity in the allocation of health care resources. Health Econ. 2000 Oct;9(7):571–574. doi: 10.1002/1099-1050(200010)9:7<571::aid-hec555>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
- Sørensen R. J., Grytten J. Contract design for primary care physicians: physician location and practice behaviour in small communities. Health Care Manag Sci. 2000 Feb;3(2):151–157. doi: 10.1023/a:1019041307532. [DOI] [PubMed] [Google Scholar]
- Watt I. S., Franks A. J., Sheldon T. A. Health and health care of rural populations in the UK: is it better or worse? J Epidemiol Community Health. 1994 Feb;48(1):16–21. doi: 10.1136/jech.48.1.16. [DOI] [PMC free article] [PubMed] [Google Scholar]