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Related Experiment Videos

Attempt at deriving a formula for setting general practitioner fundholding budgets

T A Sheldon1, P Smith, M Borowitz

  • 1NHS Centre for Reviews and Dissemination, University of York.

BMJ (Clinical Research Ed.)
|October 22, 1994
PubMed
Summary

Routine data cannot create equitable general practitioner fundholder budgets. Age and sex are the main drivers of variation, but other health needs factors are not adequately captured by current utilization data.

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Area of Science:

  • Health economics
  • Public health policy
  • Healthcare management

Background:

  • General practitioner (GP) fundholding requires equitable budget allocation for purchasing acute hospital services.
  • Existing capitation formulas may not accurately reflect population health needs.
  • A robust system is needed to ensure fairness and efficiency in healthcare resource allocation.

Purpose of the Study:

  • To investigate the feasibility of using routine data sources to develop weights for an equitable GP fundholding capitation formula.
  • To assess the adequacy of current utilization data for adjusting budgets based on population health needs.

Main Methods:

  • Analysis of 9 million hospital episodes from 1991-2, focusing on elective GP fundholding procedures.
  • Integration of 1991 census data, vital statistics, and ward-level healthcare supply information.

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  • Modeling of expenditure variations across wards, adjusting for health and social needs and supply factors.

    • Main Results:

    • No simple model effectively explained expenditure variation beyond age and sex.
    • While mortality ratios, self-reported illness, and social class showed associations, their impact was contradictory and inconsistent.
    • Age and sex differences were the primary determinants of utilization variation between wards.

    Conclusions:

    • An equitable system for setting GP fundholder budgets is essential.
    • Age and sex-weighted capitation should be the primary basis for budgets in the short term.
    • Ward-level utilization data is insufficient for accurately adjusting capitation formulas for diverse population health needs.
    • Individual cohort data may be necessary for a truly equitable and efficient capitation formula.