Sheldon T A, Smith G D, Bevan G
Centre for Health Economics, University of York, Heslington.
BMJ. 1993 Mar 27;306(6881):835-9. doi: 10.1136/bmj.306.6881.835.
National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper argues that the search for an empirically based resource allocation formula of high precision in the name of promotion of equity is largely fruitless given the impossibility of measuring the true need for, and costs of, providing health care, especially with the limited data available. The inclusion of measures of social deprivation is also poorly thought out. The availability of data from the 1991 census, which included a question regarding long-standing illness, together with the intention of the Department of Health to review the weighted capitation formula using this information may stimulate much work but little light. It is essential that the impact of resource allocation formulas is justifiable on grounds other than the composition of any particular formula.
国家向地区卫生当局分配资源，再由地区卫生当局向各地区分配资源，目前是由一个加权人头公式决定的。国家公式源自回归分析，以医院利用率作为医疗需求指标——这种方法存在根本局限性。本文认为，以促进公平之名寻找一个基于实证的高精度资源分配公式基本上是徒劳的，因为无法衡量提供医疗服务的真正需求和成本，尤其是在可用数据有限的情况下。将社会剥夺措施纳入其中的考虑也欠周全。1991年人口普查的数据中包含了一个关于长期疾病的问题，加上卫生部打算利用这些信息审查加权人头公式，这可能会引发大量工作，但却收效甚微。资源分配公式的影响必须基于任何特定公式的构成之外的其他理由才说得通。
