The natural life of policy indices: geographical problem areas in the U.S. and U.K

In spite of many fundamental differences between the health systems in the U.S. and U.K., each has pursued a policy of identifying geographical small-areas believed to have inadequate primary care physicians given local health care needs. The magnitude of the problems in such areas differ in the U.S. and U.K. leading to idiosyncratic policy responses that are dictated by overall health system realities. However, there are several common themes identified in this comparative study: goals for remedial health policy are often unclear, making evaluation difficult; in the absence of conceptual clarity, a consensus-based approach of identifying existing and widely available variables to designate areas has been used to identify geographical problem areas; there are widespread concerns that the present indices used to implement policy are inappropriate, but no alternative index has been adopted. The paper concludes that clarifying goals for remedial health policy is key if the effectiveness of such policy is to be improved. Guidelines for assessing the usefulness of existing and future indices used to designate areas as eligible for resources as a part of this type of small-area remedial policy are developed from this U.S./U.K. comparison.