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Cross-Regional Equality in Health Care Funding

  • Bond. D.

    (University of Ulster at Coleraine)

  • Conniffe.D.

    ()

    (Economics, NUI Maynooth, Ireland)

In Ireland, as in many other countries, much health care provision is State funded and State provided. Equity, in the sense of equality of 'treatment' for individuals with the same health needs irrespective of their geographical locations, or incomes, has been, and is, very much stressed as an appropriate policy objective. However, health care delivery in Ireland (and in some other countries including the UK) operates through regionally based Health Boards responsible for provision in their own regions. This implies mechanisms for funding allocations to Boards that allow for the corresponding regional needs, but the choice of mechanism is not at all a simple or non-contentious topic. It is important though, and so a very appropriate topic for research by the National Institute for Regional and Spatial Analysis. This Working Paper is at least a first step in a relevant investigation. Following much research, formulae have been developed in the UK for the allocation of health care funding across regions with the objective of attaining regional equity in health care. The formulae employ criteria such as regional populations, age and gender distributions, and regional morbidity and socio-economic measures. The UK work is a natural starting point for corresponding Irish formulae. So one theme of this paper is a critical review of the UK's formula based system, looking at the theory and methodology underlying the derivation of formulae and assessing how the system has actually worked in Northern Ireland. However, we think it is also important to critically examine the apparent primacy granted to the objective of equity attainment. As regards the first theme, we conclude some assumptions are implausible and some issues unresolved and we discuss the implications should a formula based regional allocation strategy be desired for Ireland. As regards the second theme, we find that healthcare equity - in spite of its primacy in many minds - is an elusive entity, very hard to measure, let alone achieve. Making it a primary objective in health care provision carries a price as regards attainment of other objectives and this, along with its elusiveness, deserves consideration by health economists and policy makers.

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Paper provided by Department of Economics, Finance and Accounting, National University of Ireland - Maynooth in its series Economics, Finance and Accounting Department Working Paper Series with number n1120102.

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Date of creation: Feb 2002
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Handle: RePEc:may:mayecw:n1120102
Contact details of provider: Postal: Maynooth, Co. Kildare
Phone: 353-1-7083728
Fax: 353-1-7083934
Web page: http://www.maynoothuniversity.ie/economics-finance-and-accounting

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  1. Roy Carr-Hill & Geoffrey Hardman & Stephen Martin & Stuart Peacock & Trevor Sheldon & Peter Smith, 1994. "A formula for distributing NHS revenues based on small area use of hospital beds," Working Papers 022cheop, Centre for Health Economics, University of York.
  2. Carol Propper, 2001. "Expenditure on healthcare in the UK: a review of the issues," Fiscal Studies, Institute for Fiscal Studies, vol. 22(2), pages 151-183, June.
  3. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
  4. Matthew Sutton & Peter Lock, 2000. "Regional differences in health care delivery: implications for a national resource allocation formula," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 547-559.
  5. Richard Blundell & Frank Windmeijer, 2000. "Identifying demand for health resources using waiting times information," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 465-474.
  6. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
  7. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
  8. Nolan, Brian, 1993. "Charging for Public Health Services in Ireland: Why and How?," Research Series, Economic and Social Research Institute (ESRI), number PRS19.
  9. George Davey Smith & Stephen Frankel & Shah Ebrahim, 2000. "Rationing for health equity: is it necessary?," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 575-579.
  10. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
  11. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
  12. Peter C. Smith & Nigel Rice & Roy Carr-Hill, 2001. "Capitation funding in the public sector," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 164(2), pages 217-257.
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