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

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Hauck, K. ; Shaw, R. ; Smith, P.C. (2002)

Traditionally, 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.
  • References (31)
    31 references, page 1 of 4

    1. Rice N, Smith, P. Capitation and risk adjustment in health care financing: an international progress report. The Milbank Quarterly, 2001; 79: 81-113.

    2. Resource Allocation Working Party. Sharing Resources for Health in England. HMSO: London, 1976.

    3. Royston GHD, Hurst JW, Lister EG, Stewart PA. Modelling the use of health services by populations of small areas to inform the allocation of central resources to larger regions. Socio-Econ Plann Sci 1992; 26: 169-180.

    4. Smith P, Rice N, Carr-Hill R. Capitation funding in the public sector. J Roy Statist Soc Ser A, 2001; 164: 217-257.

    5. Carr-Hill RA, Sheldon TA, Smith P, Martin S, Peacock S, Hardman G. Allocating resources to health authorities: development of methods for small area analysis of use of inpatient services. British Med J 1994; 309: 1046-1049.

    6. Welsh Office. NHS Resource Allocation Review: Emerging Findings Report to the Health and Social Services Committee. Welsh Office: Cardiff; 2001.

    7. Department of Health and Social Services. Allocating Resources to H&SS Boards: Proposed Changes to the Weighted Capitat Formulae - A Third Report from the Capitation Formula Review Group. Department of Health and Social Services: Belfast; 2001.

    8. Scottish Executive Health Department. Fair Shares for All: Final Report. Scottish Executive Health Department: Edinburgh; 2000.

    9. Ha.kkinen U, Mikkola HM, Nordberg M, Salonen M. Tutkimus Kuntien Terveyspalveluiden Valtionosuuksien Perusteista [A Study on the Foundations of the State Subsidies for Municipal Health Services]. Sisa.asiainministeri o.: Helsinki; 1996.

    10. Pampalon, R. L'approche que!be!coise en matie"re d'indicateurs de besoins pour l'allocation re!gionale des ressources, in CREDES. In Allocations des Ressources, Ge!ographie des Soins. CREDES: Paris; 1998.

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