Sims A, Redgrave P, Layzell A, Grimsley M, Wisher S, Martin D
Doncaster Health Authority, Doncaster.
J Public Health Med. 1997 Dec;19(4):380-6. doi: 10.1093/oxfordjournals.pubmed.a024664.
Current resource allocation for health services have developed in a haphazard and inequitable way. This project aimed to determine a fairer and more rational way to distribute health authority's (HA's) money to general practitioners (GPs).
A dataset was developed to examine the way resources were spent on patients at the level of general practice. Important managerial aspects of the project were addressed. This involved the establishment of the 'Equity Group' of GPs to work with the HA. The group sought a measure of health need that was rigorous and scientifically based but was also practical and politically acceptable to GPs and the HA. The York Relative Needs Index (RNI) was chosen, and applied to populations at practice level. An implementation plan was then developed by the Equity Group.
Results demonstrated considerable inequalities between practices in age-adjusted use of healthcare resources. There was low correlation between the level of need in practices and the per capita expenditure. Applying the York RNI to practice populations indicated current practice allocations were within the range 82-126 per cent of their needs-based target. The managerial implications of the proposed changes are described.
The new methods for resource allocation appear to be an advance on the unplanned methods which have evolved. Full evaluation of the long-term results of redistributing health resources will be needed. Important aspects of this project were the participation of GPs and general development of the concept of equity in North Derbyshire.
当前卫生服务资源分配方式杂乱且不公平。本项目旨在确定一种更公平、更合理的方式，将卫生当局（HA）的资金分配给全科医生（GP）。
开发了一个数据集，以研究在全科医疗层面资源用于患者的方式。该项目涉及重要的管理方面。这包括成立全科医生“公平小组”与卫生当局合作。该小组寻求一种基于科学且严谨的健康需求衡量标准，同时该标准在实践中可行且在政治上能为全科医生和卫生当局所接受。选择了约克相对需求指数（RNI），并将其应用于各医疗机构层面的人群。然后公平小组制定了一项实施计划。
结果表明，在按年龄调整的医疗资源使用方面，各医疗机构之间存在显著不平等。各医疗机构的需求水平与人均支出之间的相关性较低。将约克RNI应用于各医疗机构人群表明，当前的机构分配在基于需求目标的82%至126%范围内。描述了拟议变更的管理影响。
新的资源分配方法似乎比已发展起来的无计划方法有所进步。需要对重新分配卫生资源的长期结果进行全面评估。该项目的重要方面是全科医生的参与以及北德比郡公平概念的总体发展。
