Mortality, morbidity, resource allocation, and planning: a consideration of disease classification

The report of the Resource Allocation Working Party recommended that revenue allocations to health authorities should be based, in part, on national patterns of bed usage and local standardised mortality ratios for conditions aggregated according to the chapters of the International Classification of Diseases (ICD). Similar criteria are now being considered for planning purposes by regions. The extent to which diseases which commonly result in the use of hospital care are also common causes of deaths within their ICD chapter was studied. National utilisation figures show that most beds in ophthalmology, ear, nose, and throat surgery, gynaecology, and consultant dentistry, and an estimated one-third or more of the beds used in general surgery, neurosurgery, and plastic surgery, are used for the treatment of conditions which are uncommon causes of death, both in absolute terms and relative to their ICD chapters. It seems unlikely that the requirements for care of patients with these diseases can be measured simply, either by all-causes mortality statistics, or by the use of mortality statistics ascribed to the ICD chapter which such diseases share with other, more common, causes of death. Consideration needs to be given to the diseases treated by each specialty in deciding whether and how to apply mortality statistics in planning for and funding the specialty.