Reducing avoidable inequalities in health: a new criterion for setting health care capitation payments

Traditionally, most health care systems which pretend to any sort of rationality and cost control have sought to allocate their limited funds in order to secure equal opportunity of access for equal need. The UK government is implementing a fundamental change of resource allocation philosophy towards contributing to the reduction of avoidable health inequalities. The purpose of this essay is to explore some of the economic issues that arise when seeking to allocate health care resources according to the new criterion. It indicates that health inequalities might arise because of variations in the quality of health services, variations in access to those services, or variations in the way people produce health, and that the resource allocation consequences differ depending on which source is being addressed. The paper shows that an objective of reducing health inequalities is not necessarily compatible with an objective of equity of access, nor with the objective of maximising health gain. The results have profound consequences for approaches towards economic evaluation, the role of clinical guidelines and performance management, as well as for resource allocation methods

Regional variation in the productivity of the English national health service

Variation in the provision of health care has long been a policy concern. We adapt the framework for productivity measurement used in the National Accounts, making it applicable for sub-national comparisons using cross-sectional data. We assess the productivity of the National Health Service (NHS) across regions of England, termed Strategic Health Authorities (SHAs). Productivity is calculated by comparing the total amount of healthcare output to total inputs for each region, standardised to the national average. Healthcare output comprises 6500 different categories, capturing the number and type of NHS patients treated and the quality of care received. Healthcare inputs include NHS and agency staff, supplies, equipment and capital. We find that productivity varies from 5% above to 6% below the national average. Productivity is highest in South West SHA and lowest in East Midlands, South Central and Yorkshire and The Humber SHAs. We estimate that if all regions were as productive as the most productive region in England, the NHS could treat the same number of patients with £3.2bn fewer resources each year. The methods developed lend themselves to investigate variations in productivity in other types of healthcare organisations and health systems

Notes from a small island: researching organisational behaviour in healthcare from a UK perspective.

This paper considers the development of research in organisational behaviour within the UK healthcare system since its foundation in 1948. It looks at the location and context of such work, given the unique setting provided in this national organisation. Contextual barriers that are both historical, political ontological and epistemological, are considered in the light of recent research developments in both academia, notably the bienniel international conference Organisational Behaviour in Healthcare (OBHC), where a search for comparative work has engaged with both the wider organisational and international communities, and government, notably the National Service Delivery and Organisation Research Programme. Confounding much of this is the absence of a way of understanding the complexity of the domain of healthcare in different contexts. The application of the Cynefin framework is then discussed as a way to aid understanding of both the organisational and research tasks, and to provide a forum for collaborative understanding to allow appropriate research and practice interventions to occur. Copyright © 2006 John Wiley & Sons, Ltd