Geoffrey Hardman

Allocating resources to health authorities: development of method for small area analysis of use of inpatient services

Every year about 22 billion pounds is allocated to health authorities for hospital and community services in England. The distribution of most of these funds is based on a formula developed to reflect the populations needs, but the existing formula has been criticised on several grounds. This paper describes the development of a method to determine the health needs for small geographical areas. Data from the hospital episodes statistics and 1991 census together with information on vital statistics and supply of health care facilities were used in the model. Two stage least squares regression was used to identify true indicators of need, and these were entered into a multilevel model to take account of variations in practice in different health authorities. The resulting formula should be more statistically robust and more sensitive to needs than previous approaches.

Allocating resources to health authorities: results and policy implications of small area analysis of use of inpatient services.

A study designed to identify the principal determinants of use of inpatient facilities in NHS hospitals in England used the data and methods outlined in the previous paper. The model for the psychiatric sector contains mortality, self reported morbidity, and social variables indicating deprivation and the level of care at home. The non-acute model contains mortality and several socioeconomic variables. The models lay less weight on age than the current formula, and a national formula based on these models would, in the acute sector, redistribute resources to poorer areas compared with the current formula.

Socioeconomic inequality in small area use of elective total hip replacement in the English National Health Service in 1991 and 2001

Objectives To compare socioeconomic inequality in small area use of elective total hip replacement in the English National Health Service (NHS) in 1991 and 2001. Methods Hospital Episode Statistics and Census data were aggregated to a common geography of ‘frozen’ 1991 English electoral wards. The Townsend deprivation score was used as the primary indicator of socioeconomic status for each ward, and the sensitivity analysis used other Census indicators. Two main measures of inequality were examined: the indirectly age-sex standardized utilization rate ratio between most and least deprived quintile groups, and the concentration index of deprivation-related inequality in age-sex standardized utilization ratios between small areas. Each standardized utilization ratio is the observed use divided by the expected use, if each age and sex group in the study population had the same use rate as the national population. Results In both years, observed use was below expected use for the bottom third of areas by socioeconomic status. The standardized utilization rate ratio between top and bottom Townsend quintiles fell from 1.41 (95% confidence interval [CI] 1.36-1.47) in 1991 to 1.27 (95% CI 1.23-1.32) in 2001. The proportionate increase in use required to bring the bottom quintile to the level of top thus fell significantly from 41% to 27%. The Town-send-based concentration index also fell from 0.069 (95% CI 0.059-0.079) in 1991 to 0.060 (95% CI 0.050-0.071) in 2001, although this fall was not statistically significant (P=0.085). Other socioeconomic indicators yielded a similar pattern. Conclusions Socioeconomic small area inequality in use of total hip replacement appears to have fallen between 1991 and 2001. One possible explanation is that increased hip replacement rates in the 1990s may have lowered barriers to access, thus allowing this health technology to diffuse further among lower socio-economic groups.

Dietary advice based on food‐specific IgG results

Purpose – To provide evidence that elimination diet based on food‐specific IgG test results is an effective, reliable and valid aid to the management of chronic medical conditions.Design/methodology/approach – A postal survey, commissioned by Allergy UK, was carried out with 5,286 subjects reporting a wide range of chronic medical conditions, who had taken a food‐specific IgG enzyme‐linked immunosorbant assay blood test. Questionnaires, issued three months after the results, were analysed to investigate the effect of eliminating the foods identified by the test. To check for response bias, a separate group of patients who had not responded were interviewed by telephone. The analysis and reporting of the data was carried out at the University of York.Findings – Of patients who rigorously followed the diet 75.8 per cent had a noticeable improvement in their condition. Of patients who benefited from following the recommendations 68.2 per cent felt the benefit within three weeks. Those who reported more than ...

The Occupational Pension Trap: Towards a Preliminary Empirical Specification

Legislation in 1985 and 1986 has attempted to give new impetus to the growth of occupational and personal pension schemes. This article demonstrates that, because of the interaction between occupational pensions and means-tested social security provision, many of todays pensioners receive little or no financial benefit from their occupational pension. The evidence presented is consistent with the thesis that the pensioners who are worst affected by the ‘pension trap’ include those who, as workers, were low-paid and experienced interrupted employment. As a consequence they reached retirement with small state and occupational pensions, limited savings and no house which they owned. Many are women. The penetration of occupational and personal pensions is currently lowest among the same groups of workers and it could be that the Governments policy to extend the coverage of private pensions will result in an increase in the severity of the pension trap. Some measures for reducing the impact of the pension trap are discussed.