Subregional resource allocations in the National Health Service.

Snaith, A H

doi:10.1136/jech.32.1.16

Cited by 17 publications

(7 citation statements)

References 6 publications

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“…At the local authority level variations in morbidity were found to be associated with over 60% of the variation in all cause mortality 17 and a strong correlation (r=0.8) was also found by Charlton et al 16 We have found that this relation is much weaker at lower levels of aggregation. 3 In the multilevel modelling, variations in the health outcomes remain after controlling for age, sex, and deprivation, however the addition LLTI to the mortality model and vice versa has a minimal impact.…”

Section: Discussionmentioning

confidence: 99%

“…1 Mortality data can only provide a proxy for health rather than measure it directly, and there has been considerable debate about the limitations of the measure. [2][3][4][5][6] It has also been suggested that the inadequacy of the SMR as an indicator of morbidity would become more marked for lower levels of aggregation because of the smaller number of deaths involved, 3 although to date this suggestion has not been explored. 1 The introduction of a question on limiting long term illness (LLTI) in the 1991 UK census provided for the first time information on perceived levels of morbidity at the small area level.…”

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confidence: 99%

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Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Barnett

Roderick

Martin³

et al. 2002

Journal of Epidemiology &Amp; Community Health

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Study objective: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. Design: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991-1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. Setting: Nine counties in the south west of England. Participants: Those aged between 0-64 who reported having a LLTI in the 1991 census, and those who died during 1991-1996 aged 0-74. Main results: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. Conclusions: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Barnett

Roderick

Martin³

et al. 2002

Journal of Epidemiology &Amp; Community Health

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“…The service increments for teaching (SIFT) were not discussed for example, although they are considered by Snaith (1978); these calculations are not clearly related to any of the criteria given in the terms of reference and they raise new issues, especially concerning standards. Enough has been said to show that the RAWP's proposals are logically untidy, contain many contradictions and inconsistencies, and engender serious difficulties of interpretation and implementation at practical levels.…”

Section: Next Time Roundmentioning

confidence: 99%

Principles of allocation of health care resources.

Knox¹

1978

Journal of Epidemiology & Community Health

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“…This general approach led to a series of which claimed to discredit SMRs (e.g. Snaith 1978). However, Forster's conclusions can be turned on their head if the General Household Survey morbidity measme is related to the concept of relative need for health care (i.e.…”

Section: Mortality and Morbidity Correlationsmentioning

confidence: 99%

Measuring Need in the National Health Service Resource Allocation Formula: Standardized Mortality Ratios or Social Deprivation?

Mays

1987

Public Administration

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All methods of dividing public expenditure between competing claims become contentious, particularly when they rely on social indicators of need. The Resource Allocation Working Party (RAW) formula devised in 1976 for distributing National Health Service financial resources fairly between different parts of England relies on the size, age/sex structure and mortality rates (in the form of standardized mortality ratios – SMRS) of populations as combined surrogates for their need for health care. This paper aims to demonstrate three things: first, that RAW'S approach in selecting SMRS was sure‐footed; second, that no better proxy of health care need which could be used in RAW has been produced since RAW; and third, that the continuing criticism of SMRS has been sustained by political pressures within the NHS. The result has been the application of ever more indirect and complex surrogates for‘need in the resource allocation process which are known to be contaminated by the prevailing unequal supply of health service facilities.

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Subregional resource allocations in the National Health Service.

Cited by 17 publications

References 6 publications

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Principles of allocation of health care resources.

Measuring Need in the National Health Service Resource Allocation Formula: Standardized Mortality Ratios or Social Deprivation?

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