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Biomedical subjects

G Bevan

Publications and source records attributed to G Bevan.

At least 37 records · Page 2Linked to original sources
PubMed1989

Working for which patients and at what cost?

The Government's white-paper Working for Patients proposes introducing a system in which publicly financed resources for hospital and community health services will be distributed to districts and general practitioners with practice budgets for them to choose between competing providers from both the public and private sectors. The NHS Management Board in 1986 observed that such a system would be costly and impractical and would require careful pilot work in situations where its benefits are likely to outweight its costs. This paper shows that there is no reason for changing that judgement.

Adult↗
PubMed1988

Medical research.

Explore the source record for details and available documents.

Education, Medical↗
PubMed1987

Reviewing RAWP. Variations in admission rates: implications for equitable allocation of resources.

The review of the Resource Allocation Working Party (RAWP) formula by the National Health Service Management Board has considered the method used to account for cross boundary flows between health authorities. There is no consensus on how this should be done subregionally, as it raises the unresolved problem of the best method of estimating the size of catchment populations. Different methods produce different population sizes when the admission rates of individuals living in different districts vary. The National Health Service/Department of Health and Social Security acute services working group on performance indicators recently considered the assumptions made by different methods in terms of admission thresholds set by hospital clinicians. More complicated methods of assessing catchment areas seem to offer little advantage over the simplest method, but none of the methods answer the underlying questions of what truly determines admission rates and whether higher admission rates are better than lower ones. Empirical research into variations in admission rates and their relation to outcomes is important for determining the fair allocation of resources in future.

Catchment Area, Health↗
PubMed1987

Reviewing RAWP. Is the medical service increment for teaching (SIFT) adequate?

One issue of interest to the current review of the Resource Allocation Working Party (RAWP) formula is the extra service costs associated with medical teaching. RAWP intended the medical service increment for teaching (SIFT) to cover these costs. Although it is not possible to assess from the methods used to derive the SIFT rate whether it is or is not overgenerous for its intended purpose, the "excellence" elements of teaching hospitals tend to be protected. The financial problems of the teaching hospitals are more likely to be due to the relatively high use of services by local residents. But cutting services of London teaching hospitals to bring this use down to equitable levels may impair their capacity to train medical students.

Health Resources↗
PubMed1987

Financial incentives of subregional RAWP.

Accounting for the cross boundary flows of residents from one health authority treated by another has been considered by the review of the Resource Allocation Working Party (RAWP) formula by the National Health Service Management Board. A common concern is that the approximate costs used are unfair to those authorities (typically those with teaching hospitals) that are likely to treat more complex cases. This paper argues that when spending exceeds the target allowance for acute services this is more likely to be due to district residents using services at a high rate than to inadequate compensation for inflows. Districts where residents make a high use of services are often those where there are large flows across district boundaries. Since authorities cannot control outflows there is little they can do to reduce their residents' high use of services. Furthermore, curious financial incentives can be inferred for clinicians in these districts if they were to take effective action to bring their district's spending to target levels. These problems are discussed to illuminate problems of accounting for cross boundary flows that alternatives to current practice must resolve.

Health Resources↗
PubMed1987

Making access to health care more equal: the role of general medical services.

The Resource Allocation Working Party (RAWP) recognised the need to consider both health authority and primary care services in achieving its objective. RAWP and the subsequent Advisory Group on Resource Allocation (AGRA) found (but did not publish) considerable variation in resources used by both services but could not find a clear relation between them. Statistics provided by the DHSS were used to compare spending by 80 area health authorities in 1980-1 with expenditure per head on general medical services by their corresponding family practitioner committees. There was considerable variation in the provision of resources for both services and no clear relation between the variations in spending on each service. Only 40 of the 80 areas had both health authority and family practitioner committee spending levels within 10% of "target." Subregional inequalities in resources tend to be related to variations in admission rates, which in turn are related to general practitioners' referral behaviour. These results emphasise the importance of finding out more about inequalities in the provision of general medical services and their relation to the use of hospital services. They also suggest that RAWP's aim of equality of opportunity of access to health care resources may be achieved only if general medical services are brought into the equation as well.

Family Practice↗
PubMed1978

Secretion of intrinsic factor and hydrochloric acid after 12 weeks' treatment with cimetidine.

A sample of 16 patients had pentagastrin stimulation studies performed before starting a 12 week course of cimetidine, and again 12 hours after completing the course. Basal and pentagastrin stimulated intrinsic factor secretion was assayed in 13 patients. There was no significant difference in the pattern of secretion after 12 weeks' treatment with cimetidine. The basal and peak acid outputs of all 16 patients were measured. No significant difference was found in the pattern of acid secretion after treatment. It appears that parietal cell secretory function is restored to normal within 12 hours of discontinuing a prolonged course of cimetidine.

Cimetidine↗