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PubMedDate not supplied

The determinants of hospital utilisation: implications for resource allocation in England.

Since 1976 various attempts have been made to ensure that NHS resources available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The current method is based on analyses of the links between observed patterns of in-patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this approach, however, and so the search continues for new analytical techniques. The purpose of this paper is to explore how household survey data about 12,729 English adults could be used to inform resource allocation decisions. Health care need indicators can be developed based on Census information and odds ratios derived from logistic regression analyses of the relationships between hospital utilization, health status, socio-demographic characteristics and area indicators of supply. The results suggest that health status is the most important determinant of hospital utilization, although demographic and socio-economic factors also have some influence. In addition to the personal characteristics of individual respondents, area correlates of health care supply are also positively associated with reported utilization. The final part of the paper illustrates how weighted population estimates might be calculated on the basis of empirically-derived indicators of health care need.

Adult↗
PubMed1994

Minnesota public opinion on health care resource allocation.

Creating workable policies for allocating or rationing finite health care resources to meet the needs of individuals as well as the broader society vexes policymakers, providers, and consumers. This paper presents results of a March 1994 Lou Harris survey of 1,006 Minnesotans about health care allocation. Minnesotans believe that allocative or rationing decisions are inevitable and can be discussed. Individualized bedside allocative decisions are preferable to categorical or universal exclusions of some health care benefits. People want comprehensive health care and are willing to let sound clinical judgment, perhaps informed by practice guidelines, selectively withhold some services. The integrity of plan-based allocation or rationing may be best secured and safeguarded by standards that ensure that the decisions are based on patients' best interests, involve trusted clinical decision makers, and include lay participation in the decision making.

Adolescent↗
PubMed1989

Comparison of two scores for allocating resources to doctors in deprived areas.

Current proposals in the general practitioner contract include additional payments to doctors working among deprived populations. The underprivileged area score will be used to identify local authority wards with the greatest levels of deprivation, thus acting as the basis for distributing considerable resources. Two methods of identifying deprived populations--the underprivileged area score and the material deprivation score--were compared to determine whether they result in similar allocation of resources to regions. Financial allocations to regions based on figures derived from the contract differed considerably if the material deprivation score was used instead of the underprivileged area score: Northern and Mersey regions gained over 50% of their allocation whereas East Anglia, Oxford, and South West Thames regions lost more than 30% of theirs. Such differences have considerable implications for doctors working among deprived populations as up to 60m pounds each year might be distributed by these payments.

England↗
PubMed1987

Waiting for care. Queuing and resource allocation.

Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days for nonemergency care leading to hospitalization, including primary and specialty ambulatory care, for that one quarter of patients who had been placed on a waiting list. Of the remaining hospitalized population one half were admitted immediately and another one fourth were either booked or transferred from other hospitals. The widely accepted notion that a large majority of hospitalized patients wait a long time for care in Britain is mistaken. The emphasis on primary ambulatory care means that essentially no one has to wait for general practitioner care. The wait for elective ambulatory specialty care averaged approximately 8 weeks for all patients. Although mortality is rarely an issue for those who wait, an argument can be made that convenience and quality of life are importantly affected.

Ambulatory Care↗