Search PubMed⌕ Search

Biomedical subjects

G Bevan

Publications and source records attributed to G Bevan.

At least 19 recordsLinked to original sources
PubMed2000

Estimating the "avoidable" burden of disease by Disability Adjusted Life Years (DALYs).

The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the "avoidable" burden of disease. We identify different ways of measuring DALYs: incidence-based DALYs are appropriate where the means of reducing the burden of disease is by prevention; prevalence-based DALYs are appropriate when a disease cannot be prevented but effective treatment is available. The methods of estimating each are explained and we describe how we have applied these methods to seven causes of death and disability in the South and West Region. We discuss the relevance of this work for monitoring the health of populations and deciding how best to use scarce resources to improve health.

Age Factors↗
PubMed1999

Service increment for teaching (SIFT): a review of its origins, development and current role in supporting undergraduate medical education in England and Wales.

OBJECTIVES: To describe the ways in which total resources available for the Service Increment for Teaching (SIFT) have been determined and related to numbers of undergraduate medical students; and the development and current arrangements for allocating SIFT to the providers of service support for teaching. DESIGN: The derivation of SIFT from excess costs of teaching hospitals over general hospitals is described. The official principles of organizing SIFT to reimburse the service costs of teaching undergraduate medical students are explained. The crucial development that is examined is the change from SIFT being a global subsidy to being related to educational contracts. This development has facilitated both the specification of standards and innovative uses of SIFT. These are illustrated with examples. SETTING: Hospital and Community Health Services and Primary Care in the National Health Service (NHS) in England and Wales. SUBJECTS: Medical students. RESULTS: There is often confusion caused by SIFT being intended to cover the service costs of teaching but not having been derived in this way. This causes problems in deciding what providers should be paid through contracts for teaching of different kinds. CONCLUSIONS: The new contractual basis has enabled medical schools to use contracts to improve the clinical teaching of undergraduate medical students in the NHS. These developments may offer useful models for other countries.

Cost Allocation↗
PubMed1999

An economic model to estimate the relative costs over 20 years of different hip prostheses.

STUDY OBJECTIVE: To determine the relative costs of prostheses and factors associated with changes in these cost rankings. DESIGN AND SETTING: Economic model using published data. MAIN RESULTS: The main cost drivers are current costs and revision rates. Expected revision costs are a small proportion of the expected total costs. There are few competitors to the "gold standard" Charnley in terms of total expected costs over 20 years. There is no monetary advantage in using higher cost prostheses in older patients even if they were to have lower revision rates. There may be a monetary case for using prostheses with higher costs and lower revision rates in younger patients. CONCLUSIONS: The most cost effective prosthesis in older patients is the Stanmore. The Charnley, Exeter Polished and Muller Straight Stem are marginally more costly than the Stanmore. The study inevitably lacks good data on survival for newer prostheses. This does not affect the ability to make choices for older patients. Data are needed, however, on survival of cemented prostheses for younger patients.

Age Factors↗
PubMed1999

Point of care testing in the accident and emergency department: a cost analysis and exploration of financial incentives to use the technology within the hospital.

OBJECTIVES: To compare the costs of current arrangements for testing emergency blood samples from patients attending an accident and emergency (A&E) department in a large teaching hospital in England with point of care testing (POCT). METHODS: Estimates were made of the fixed and variable costs of two options: a supplemental option, in which POCT was introduced to A&E only; and a replacement option, in which POCT was introduced to A&E and the intensive therapy unit (ITU), thereby entirely replacing an existing process. RESULTS: For the supplemental option, current arrangements cost 68,466 Pounds in total per year; average costs per test were 5.53 Pounds (venous in the central laboratory) and 3.60 Pounds (arterial on the ITU). Introducing POCT would increase total hospital costs by 35,929 Pounds, and average costs per test would be 5.32 Pounds (venous) and 4.28 Pounds (arterial). For the replacement option, current arrangements cost 132,630 Pounds in total, and average cost per test (for all tests) was 4.06 Pounds. Introducing POCT would make hospital savings ranging from 8332 Pounds to 20,000 Pounds, and average cost per test would be 3.78 Pounds. CONCLUSIONS: Introducing POCT results in lower average costs per test. The supplemental option will result in significantly increased costs to the hospital. The replacement option can lead to significant savings. The internal cross-charging arrangements between departments that exist in this hospital may mean that supplemental implementation of POCT could be potentially 'profitable' for the A&E department, but would result in higher expenditure for the hospital as a whole.

Blood Chemical Analysis↗
PubMed1997

Purchasing evidence: the corollary of evidence-based purchasing.

The National Health Service (NHS) market led to problems in funding research and development (R&D). The current policy is to resolve these by funding R&D through a national levy on purchasers. The policy does not, however, address the underlying problem that evidence produced by R&D is largely irrelevant to purchasers. The consequences of this policy are likely to be that purchasing will have limited impact in securing health gain most effectively, the progress and impact of R&D will be impaired, and its funding will remain insecure. If R&D and purchasing were integrated each could become more effective. This integration can be fostered through developing the regulation of purchasers and providers within the NHS market.

Community Participation↗
PubMed1997

Estimating the burden of disease in an English region.

BACKGROUND: Health Authorities seeking to make appropriate investments in health care require information about the nature of the burden of disease in their populations. The World Bank instrument called DALY-Disability Adjusted Life Year-has been used in the South and West Region to measure this burden. METHOD: The burden of disease caused by a selection of diseases has been calculated using DALYs, which combine premature mortality and disability. An estimate of the total burden has been estimated by ICD chapter. RESULTS: Premature mortality accounts for 52 per cent of the burden of disease and disability 48 per cent. Mental illness, for which its DALY value is largely derived from disability not premature mortality, contributes the third largest component of the total burden, after heart disease and cancer. DISCUSSION: DALYs can be calculated using UK data, and, with an appreciation of the theoretical issues which surround the calculations, can be used to describe the burden of disease in a population. Although designed to assist investment decisions in developing countries, the DALY is likely to be valuable in established market economies.

Algorithms↗
PubMed1996

Determining the size of a total purchasing site to manage the financial risks of rare costly referrals: computer simulation model.

OBJECTIVE: To estimate the financial risks of 15 categories of rare costly referrals for total purchasing sites of different population sizes. DESIGN: Computer simulation of 100 fund years assuming Poisson distribution of referrals. SETTING: British general practices that have opted to become total purchasing sites. Referral rates and price estimates were supplied by South and West Devon Health Commission. MAIN OUTCOME MEASURES: Variation in referral costs to purchasers in relation to size of risk pool (person years at risk). RESULTS: Random variation in referral costs increased as the size of the risk pool decreased. Variation increased greatly below 30,000 person years. The mean simulated cost of the referral categories considered was 2.8% of total NHS hospital and community service costs, and the maximum simulated cost for 7000 person years was 6.8%. Simulated variation was robust to assumption about prices and referral rates for specific types of referral. CONCLUSION: Rare costly referrals seem unlikely to bankrupt total purchasing sites. The management of risk is not in itself justification for total purchasing to be based in several general practices in order to generate large populations. There are other ways of managing risk. Sites can easily explore options by simulations using local referral rates and prices.

Computer Simulation↗
PubMed1996

The prevalence and direct costs of pre-immunization testing for hepatitis A in general practice.

Two hundred and twenty patients in one general practice travelling to destinations where immunization against hepatitis A virus (HAV) is recommended were tested for their HAV immune status before immunization. Age-specific prevalence of prior immunity to HAV was estimated. The relative costs of pre-immunization testing and immediate immunization were compared. The most cost-effective testing method for this practice was found to be total population testing prior to immunization with HAV vaccine. Individual general practices can estimate the optimal age at which to commence testing for HAV in their own practice population.

Adolescent↗
PubMed1995

Ways of seeing: explaining variations in use of acute hospital services.

BACKGROUND: In the US Medicare programme, hospitals are paid directly by activity. To provide incentives for efficiency, the US Federal Government has sought objective measures of inpatients' need for resources. In the UK National Health Service, resources are allocated for acute hospital services as part of a global budget to purchasers, who then contract with hospitals. To provide equity in resource allocation, the Department of Health in England, has sought objective measures of populations' need for resources. METHODS: Examination of policy and technology that has used variations in utilization of resources to derive objective measures of efficiency and equity. RESULTS: The technology of developing empirical measures of resources needed by patients has lacked information on outcomes, which is vital for measures of efficiency. The technology of developing empirical measures of resources needed by populations has relied on aggregate data. Analyses of specific procedures and conditions consistently find that these variations are explained by differences in medical practice and not by need. CONCLUSIONS: There is scope for multidisciplinary research to explain small area variations for specific procedures and conditions in resources used by populations. It seems unlikely, however, that governments will be interested in findings from this research.

Health Care Rationing↗
PubMed1993

Weighting in the dark: resource allocation in the new NHS.

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.

Delivery of Health Care↗
PubMed1992

Dolce vita.

Explore the source record for details and available documents.

Contract Services↗