The impact of private sector provision on equitable provision of coronary revascularisation

Objective: To investigate the impact of including private sector data on assessments of equity of coronary revascularisation provision using NHS data only. Design: Analyses of Hospital Episodes Statistics and private sector data by age, sex, and PCT of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. GINI coefficients were derived to provide an index of inequality across sub-populations, with parametric bootstrapping to estimate confidence intervals. Setting: London Participants London residents undergoing coronary revascularisation April 2001 - December 2003. Intervention Coronary artery bypass graft or angioplasty Main outcome measures: Directly-standardised revascularisation rates, GINI coefficients. Results: NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p=0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately-funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS funded care alone. Conclusion: Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place

Incentives for separation and incentives for public good provision

In this paper I examine the incentives of regions to unite, to separate and to provide public goods. Separation allows for greater influence over the nature of political decision making while unification allows regions to exploit economies of scale in the provision of public goods. When public good provision is relatively inexpensive, separation occurs since individuals want to assert greater influence, while for intermediate costs of public good provision, separation can be explained by the desires for greater influence as well as for more public goods. Compared with the social optimum, there are excessive incentives for public good provision as well as excessive incentives for separation

The Provision of Paralegal Education in Scotland

This research follows on from research on the Provision of Legal Education in Scotland conducted for the Open University in 2010 and on research mapping the PDA curriculum with the Skills for Justice functional map in 2012. The focus of this research is to map the provision of paralegal education in Scotland and identify gaps in that provision