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The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations?

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  • Asthana, Sheena
  • Gibson, Alex
  • Moon, Graham
  • Dicker, John
  • Brigham, Philip

Abstract

Although the English NHS has been described as a world leader in pioneering methods of distributing expenditure in relation to population needs, concerns about the legitimacy of using the current utilisation-based model to allocate health service resources are mounting. In this paper, we present a critical review of NHS resource allocation in England and demonstrate the feasibility and impact of using direct health estimates as a basis for setting health care capitations. Comparing target allocations for the inpatient treatment of coronary heart disease in a sample of 34 primary care trusts in contrasting locations in England, we find that a morbidity-based model would result in a significant shift in hospital resources away from deprived areas, towards areas with older demographic profiles and towards rural areas. Discussing the findings in relation to a wider policy context that is generally concerned to direct more health care resources towards the poor, the paper concludes by calling for greater clarity between the goals of health care equity and health equity. Whilst the former demands that the legitimate needs of demographically older populations for more health care resources are acknowledged, the goal of health equity requires real political commitment to resource broader social policy initiatives.

Suggested Citation

  • Asthana, Sheena & Gibson, Alex & Moon, Graham & Dicker, John & Brigham, Philip, 2004. "The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations?," Social Science & Medicine, Elsevier, vol. 58(3), pages 539-551, February.
    • Handle: RePEc:eee:socmed:v:58:y:2004:i:3:p:539-551
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    Citations

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    Cited by:

    1. Alessio Petrelli & Roberta Picariello & Giuseppe Costa, 2010. "Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services," International Journal of Health Economics and Management, Springer, vol. 10(1), pages 29-42, March.
    2. van Noort, Olivier & Schotanus, Fredo & van de Klundert, Joris & Telgen, Jan, 2018. "Explaining regional variation in home care use by demand and supply variables," Health Policy, Elsevier, vol. 122(2), pages 140-146.
    3. Antonio Clavero Barranquero & Mª. Luz González Alvarez, 2005. "A survey of econometric models to analyze the demand and utilisation of health care," Hacienda Pública Española / Review of Public Economics, IEF, vol. 173(2), pages 129-162, June.
    4. Asthana, Sheena & Gibson, Alex, 2011. "Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?," Health Policy, Elsevier, vol. 101(2), pages 133-139, July.
    5. Longduoqi A & Hang Ma & Mohan Wang & Biao Yang, 2022. "Research on Urban Community Elderly Care Facility Based on Quality of Life by SEM: Cases Study of Three Types of Communities in Shenzhen, China," Sustainability, MDPI, vol. 14(15), pages 1-23, August.
    6. Laura Vallejo‐Torres & Stephen Morris, 2013. "Income‐Related Inequity In Healthcare Utilisation Among Individuals With Cardiovascular Disease In England—Accounting For Vertical Inequity," Health Economics, John Wiley & Sons, Ltd., vol. 22(5), pages 533-553, May.
    7. Per-Åke Andersson & Daniel Bruce & Anders Walander & Inga Viberg, 2011. "Time for a new budget allocation model for hospital care in Stockholm?," Health Care Management Science, Springer, vol. 14(1), pages 36-55, March.
    8. Smith, Samantha & Walsh, Brendan & Wren, Maev-Ann & Barron, Steve & Morgenroth, Edgar & Eighan, James & Lyons, Seán, 2019. "Geographic profile of healthcare needs and non-acute healthcare supply in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS90, June.
    9. Vallejo-Torres, Laura & Morris, Stephen & Carr-Hill, Roy & Dixon, Paul & Law, Malcom & Rice, Nigel & Sutton, Matthew, 2009. "Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption," Social Science & Medicine, Elsevier, vol. 69(11), pages 1634-1642, December.

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