Search

Over the last 30 years, there has been a growing recognition of the potential for community-based efforts to improve public health. However, the costs and 'added value' of community engagement approaches remain unclear. This paper reports findings from a systematic review of the economic evidence relating to planning, design, delivery or governance of health promotion interventions. Key databases were searched, review bibliographies were checked and experts in the field of economics of public health were consulted. To be eligible for inclusion, studies needed to report community engagement or community development approaches for primary health promotion; to include a control or suitable comparator group; and to assess both health outcomes and costs. Data were extracted and studies were quality assessed. Of the 4405 references screened, 152 records (3%) were potentially relevant and eight studies met the inclusion criteria for the review. Seven studies reported positive findings, but no study was designed to evaluate the impact or cost-effectiveness of a specifically 'community-engagement' component. The review found tentative evidence that community engagement as part of a multifaceted approach to health promotion may have positive effects and could be cost-effective. To improve the evidence base for community engagement, future studies need to involve communities more closely at all stages of the research in order to fully capture the community's priorities and perspectives, and appropriately assess the value added and opportunity cost of engagement. [ABSTRACT FROM AUTHOR]

Proposes a model of the relationship between morbidity and health service utilization which allows for reporting errors and simultaneity. Expression of errors in self-reported morbidity as a function of person-specific reporting thresholds and recent contact with health services; Bias in ignoring the potential problems of reporting errors.

Focuses on the allocation of resources for health services in England. Development of a formula as basis for resource distribution; Criticisms on the formula; Determination of the health needs of people in small geographical areas.

There has been an ongoing dispute about inequalities in health ever since the suppressed publication of the Black Report in 1980. It has recently been given a new edge by three publications: the proceedings of an SSRC Workshop held in November 1983 and the Registrar General's Decennial Supplement for 1979-1983, and another half-suppressed report, this time from Health Education Council. The first and third broadly claim that inequalities in health are widening; the second that they are irrelevant. This paper reviews the debate since 1980 around the issues of measurement (how to assess differences between social groups and how to compare across time) and the four kinds of explanation examined by the Black Report. The concluding discussion emphasises the essentially political nature of the debate over the 'trends' but concludes that, whilst most agree on the importance of materialist/structuralist variables, there are differences in the policy implications of the different explanatory positions. However, on the whole these will not be resolved by 'further research': the time is long overdue for a redistribution of resources to eradicate poverty. [ABSTRACT FROM AUTHOR]

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. TO establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula. [ABSTRACT FROM AUTHOR]

Abstract: The needs component of the current formulae for allocating resources for hospital services and prescribing in England is based on a utilisation approach. This assumes that expenditure on NHS activity in different geographical areas reflects relative needs and supply conditions, and that these can be disentangled by regression models to yield an estimate of relative need. These assumptions have been challenged on the grounds that the needs of some groups may be systematically ‘unmet’. Critics have suggested an alternative based on variations in the prevalence of health conditions, called the ‘epidemiological approach’. The epidemiological approach uses direct measures of morbidity to allocate health care resources. It divides the total national budget into disease programmes based on primary diagnosis, computes the proportion of total cases for each programme in each geographical area, and then allocates budgets to geographical areas proportional to their share of total cases. The main obstacle to the epidemiological approach has been seen as its very demanding data requirements. But it also faces methodological challenges. These centre on the assumption of proportionality which, at the area level to which resources will be allocated, requires that the average level of need for ‘cases’ within each disease programme is the same in every area. We illustrate the epidemiological approach, and test the proportionality assumption underpinning it, using data from the 2002–2004 rounds of the Health Survey for England. We find regional variation in disease severity for major diseases, which suggests that health care needs for some conditions vary by area. Further analysis suggests that the epidemiological approach might systematically underallocate resources to rural areas, areas with younger populations, and deprived areas. Since the proportionality assumption underpinning the epidemiological approach does not hold, its adoption would fail to take account of variations in severity. This casts some doubt on the utility of the approach for resource allocation at the present time. [Copyright &y& Elsevier]