Allocating resources to health authorities: development of method for small area analysis of use of inpatient services

Carr‐Hill, Roy; Sheldon, Trevor; Smith, Peter; Martin, Stephen; Peacock, Stuart; Hardman, Geoffrey

doi:10.1136/bmj.309.6961.1046

Cited by 109 publications

(70 citation statements)

References 7 publications

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“…Few systems adjust for unmet need, an exception being the New Zealand formula for personal health care, in which an explicit adjustment is made to take account of the fact that the Maori population is believed to underuse health care facilities (New Zealand Ministry of Health 1996). "Supplier-induced demand" has been the subject of some concern in England, and has played a central role in determining the selection of needs factors there (Carr-Hill et al 1994). Although other countries have raised similar concerns, they have done little to address the issueexcept Belgium, where there has been considerable debate over whether to retain physician supply in the regression equations used to distribute funds to health plans (Schokkaert, Dhaene, and Van de Voorde 1998).…”

Section: Resultsmentioning

confidence: 99%

“…Empirically, in the absence of more direct measures of health care needs, some social factors (e.g., family structure and welfare status) have been found to be strongly linked to health care utilization. However, there is some concern that such relationships might reflect illegitimate supply factors rather than underlying health care needs (Carr-Hill et al 1994).…”

Section: Resultsmentioning

confidence: 99%

“…(We do not propose here to pursue what might be considered "excessive" in this context, other than to state that it reflects utilization in excess of what is usually considered to be the standard package of care.) The possibility of both unmet need and unjustified utilization has been the subject of great concern among researchers seeking to infer capitation payments from empirical data-particularly in England, where the econometric methods in use are designed specifically to minimize the impact of supply factors on estimates of capitation payments (Carr-Hill, Sheldon, Smith, et al 1994).…”

Section: The Rationale For Capitation In Health Care Financementioning

confidence: 99%

“…This approach seeks to identify expenditure responses to potential needs factors after extracting any plan-level effect. It has been tested in numerous geographically organized systems of health care, in Finland, Northern Ireland, Quebec, Scotland, and Spain, for example (Carr-Hill et al 1994; Department of Health and Social Services 1997;Häkkinen, Mikkola, Nordberg, et al 1996;Pampalon 1998;Rico 1997;Scottish Executive Health Department 1999).…”

Section: The Rationale For Capitation In Health Care Financementioning

confidence: 99%

See 3 more Smart Citations

Capitation and Risk Adjustment in Health Care Financing: An International Progress Report

2001

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In every system of health care, capitation payments have become the accepted tool used by health care purchasers in much of the developed world to determine prospective budgets. The policy prescription of capitation is perceived to address both equity objectives (of great importance in publicly funded systems of health care) and efficiency objectives (the dominant concern in competitive insurance markets). An examination of the current state of the art in 20 countries outside the United States in which health care capitation has been implemented confirms that capitation has assumed central importance within diverse systems of health care. In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: The Rationale For Capitation In Health Care Financementioning

confidence: 99%

Section: The Rationale For Capitation In Health Care Financementioning

confidence: 99%

See 2 more Smart Citations

Capitation and Risk Adjustment in Health Care Financing: An International Progress Report

2001

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“…And second, uncritical use of current utilisation as the basis for setting capitation payments might introduce a perverse incentive for local agents to increase current utilisation in order to attract higher capitation payments for their population in the future. These considerations have led to the development of a sophisticated econometric capitation methodology, principally, on the basis of small area socioeconomic data [5]. The English capitation methods have been the subject of intense scrutiny, and have been implemented, or are under consideration for implementation, in a number of jurisdictions [6][7][8][9][10].…”

Section: Capitation and Health Policymentioning

confidence: 99%

Reducing avoidable inequalities in health: a new criterion for setting health care capitation payments

2002

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SummaryTraditionally, most health care systems which pretend to any sort of rationality and cost control have sought to allocate their limited funds in order to secure equal opportunity of access for equal need. The UK government is implementing a fundamental change of resource allocation philosophy towards 'contributing to the reduction of avoidable health inequalities'. The purpose of this essay is to explore some of the economic issues that arise when seeking to allocate health care resources according to the new criterion. It indicates that health inequalities might arise because of variations in the quality of health services, variations in access to those services, or variations in the way people produce health, and that the resource allocation consequences differ depending on which source is being addressed. The paper shows that an objective of reducing health inequalities is not necessarily compatible with an objective of equity of access, nor with the objective of maximising health gain. The results have profound consequences for approaches towards economic evaluation, the role of clinical guidelines and performance management, as well as for resource allocation methods. Copyright

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Multilevel models and health economics

1997

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Multilevel analyses have become an accepted statistical technique in the field of education where over the past decade or so the methods have been developed to explore the relationships between pupil characteristics and the characteristics of the schools they attend. More recently, widespread use has extended to other social sciences and health research. However, to date, little use has been made of these techniques within the health economics literature. This paper presents an introductory account of multilevel models and describes some of the areas of health economics research that may benefit from their use.

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Allocating resources to health authorities: development of method for small area analysis of use of inpatient services

Cited by 109 publications

References 7 publications

Capitation and Risk Adjustment in Health Care Financing: An International Progress Report

Capitation and Risk Adjustment in Health Care Financing: An International Progress Report

Reducing avoidable inequalities in health: a new criterion for setting health care capitation payments

Multilevel models and health economics

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