Allocating resources to health care: RAWP (Resources Allocaton Working Party) is dead--long live RAWP

In England, according to the White Paper, "Working for Patients' the RAWP formula (Resources Allocation Working Party) is to be abandoned. Instead, according to the Working Papers, allocations are to be based on populations weighted for their health and age distributions. In the distributions from the centre to the Regions, SMRs (Standardized Mortality Ratios) are to be retained as a proxy for morbidity albeit with a different weight. This is based, partly, on the analysis carried out by Coopers and Lybrand for the RAWP Review which is shown to be inadequate both conceptually and empirically. The criteria to be used for distributing to Districts and General Practitioners are unclear but "allowance will be made for local and social factors' which suggests that some deprivation index will be incorporated into the process. The most likely choice is the Jarman index and this is shown to be equally inappropriate. The criteria used in allocation, as well as being conceptually coherent and empirically practicable, should be clear and comprehensible to all concerned. The proposals in the White Paper fulfil none of these criteria.