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Budget Allocation in the National Health Service*

Published online by Cambridge University Press:  20 January 2009

Alan Maynard  and
Anne Ludbrook
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Abstract

The objective of this article is to analyse the way in which budget allocation decisions have been made in the National Health Service (NHS) of Britain. Despite the criticisms of the pre-1948 health care system on the grounds of geographical inequity, it was not until nearly twenty-five years after the service's inception that explicit allocation formulae were devised and implemented in an attempt to achieve equity, defined as equal financial resources for health care for those in equal need.

The article is divided into four sections; the first analyses briefly the establishment of the NHS in 1948 and the failure of policy-makers to rectify the significant inequalities in the distribution of health care inputs between the regions. The second section is concerned with the official recognition of the policy problem of geographical inequality in resources and the first attempt to rectify it. In the third section the most recent set of resource allocation formulae for England, Scotland and Wales will be analysed and compared. The final section offers some brief conclusions.

Type
Articles
Information
Journal of Social Policy , Volume 9 , Issue 3 , July 1980 , pp. 289 - 312
Copyright
Copyright © Cambridge University Press 1980

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References

1 See Eckstein, H., The English Health Service, Harvard University Press, Cambridge, Massachusetts, 1964, p. 19.Google Scholar

2 See Lees, D. S. and Cooper, M. H., ‘Fee per Item of Service: Manchester and Salford, 1913–1928’, Medical Care, 2:3 (1964).Google Scholar

3 See Enquiry into the Cost of the National Health Service (Guillebaud Report), Cmd 9663, HMSO, London, 1956, p. 63.Google Scholar

4 A National Health Service, Ministry of Health, Cmd 6502, HMSO, London, 1944, p. 5.Google Scholar

5 The National Health Service Bill: A Summary of the Proposed Service, Ministry of Health, Cmd 6761, HMSO, London, 1946, p. 3.Google Scholar

6 See ‘Selection of Patients for Dialysis and Transplantation’, British Medical Journal, 2 (1978), 1,449–50.Google Scholar

7 See ‘Report of the Executive Committee of the Renal Association: Distribution of Nephrological Services for Adults in Great Britain’, British Medical Journal, 2 (1976), 903–6.CrossRefGoogle Scholar

8 Enquiry into the Cost of the National Health Service.

9 Ibid. pp. 99–104.

10 See A Hospital Plan for England and Wales, Ministry of Health, Cmd 1604, HMSO, London, 1962.Google Scholar

11 See The Hospital Building Programme: A Revision of the Hospital Plan for England and Wales, Ministry of Health, Cmnd 3000, HMSO, London, 1966.Google Scholar

12 See Feldstein, M. S., ‘Hospital Bed Scarcity: An Analysis of the Effects of Inter-Regional Differences’, Economica, 32 (1965), 393–409CrossRefGoogle Scholar; and Feldstein, M. S., Economic Analysis of Health Service Efficiency, North Holland Publishing Company, Amsterdam, 1967.Google Scholar

13 See Cooper, M. H. and Culyer, A. J., ‘An Economic Assessment of Some Aspects of the Organisation of the National Health Service’, in British Medical Association, Health Services Financing, report of a committee chaired by I. Jones, 1970Google Scholar, Appendix A; Cooper, M. H. and Culyer, A. J., ‘An Economic Survey of the Nature and Intent of the British National Health Service’, Social Science and Medicine, 5 (1971), 1–13CrossRefGoogle ScholarPubMed; and Cooper, M. H. and Culyer, A. J., ‘Equality in the National Health Service: Intentions, Performance and Problems in Evaluation’, in Hauser, M. (ed.), The Economics of Medical Care, Allen and Unwin, London, 1972.Google Scholar

14 See Cooper and Culyer, ‘Equality in the National Health Service’. For similar results in the psychiatric sector see Maynard, A., ‘Inequalities in Psychiatric Care in England and Wales’, Social Science and Medicine, 6 (1972), 221–7.CrossRefGoogle ScholarPubMed

15 See West, P. A., ‘Allocation and Equity in the Public Sector: The Hospital Revenue Allocation Formula’, Applied Economics, 5:3 (1973), 153–66.CrossRefGoogle Scholar

16 Regional Resource Allocation Formula, first interim report of the RAWP, DHSS, HMSO, London, 1975.Google Scholar

17 Sharing Resources for Health in England, report of the RAWP, DHSS, HMSO, London. 1976.Google Scholar

18 See Buxton, M. J. and Klein, R. E., ‘Distribution of Hospital Provision: Policy Themes and Resource Variations’, British Medical Journal, 1 (1975), 345–9CrossRefGoogle ScholarPubMed; Rickard, J. H., ‘Per Capita Expenditure of the English AHAs’, British Medical Journal, 1 (1976), 299–300CrossRefGoogle Scholar; and Jones, D. R. and Masterman, S., ‘NHS Resources: Scales of Variation’, British Journal of Preventive and Social Medicine, 30 (1976), 244–50.Google ScholarPubMed

19 See Sharing Resources for Health in England, para. 6:22.

20 See SirJones, F. A., ‘The London Hospitals Scene’, British Medical Journal, 2 (1976), 1,046–9Google ScholarPubMed; and Whimster, W. F., ‘Personal View’, British Medical Journal, 2 (1976), 1,318CrossRefGoogle Scholar.

21 See ‘What a RAWProar’, British Medical Journal, 2 (1976), 1,280Google Scholar.

22 See Cooper and Culyer, ‘An Economic Survey of the Nature and Intent of the British National Health Service’; and Hart, J. T., ‘The Inverse Care Law’, The Lancet, 1 (1971), 405–12.CrossRefGoogle ScholarPubMed

23 See Barr, A. and Logan, R. F. L., ‘Policy Alternatives for Resource Allocation’, The Lancet, 1 (1977). 994–7CrossRefGoogle ScholarPubMed; and Forster, D. P., ‘Mortality, Morbidity and Resource Allocation’, The Lancet, 1 (1977), 997–8.CrossRefGoogle ScholarPubMed

24 See Geary, K., ‘Technical Deficiencies in RAWP’, British Medical Journal, 1 (1977), 1,367.CrossRefGoogle ScholarPubMed

25 See Senn, S. J. and Shaw, H., ‘Resource Allocation: Some Problems in Applying the National Formula to Area and District Revenue Allocations’, Journal of Epidemiology and Community Medicine, 32 (1978), 22–7.CrossRefGoogle ScholarPubMed

26 See Buxton, M. J. and Klein, R. E., Allocating Health Resources: A Commentary on the Report of the RAWP, Research Paper no. 3, Royal Commission on the National Health Service, HMSO, London, 1978.Google Scholar

27 See Lyons, H., ‘Unless the Sums are Right the Answers will be Wrong’, Pulse, 27 01 1979.Google Scholar

28 See Fox, P. D., ‘Managing Health Resources: English Style’, in McLachlan, G. (ed.), By Guess or By What?, Nuffield Provincial Hospitals Trust, London, 1978.Google Scholar

29 See Dudley, H. A. F., ‘Loosening Patient Immobility’, The Lancet, 1 (1977), 1,251–3Google Scholar; and Klein, R. E., ‘Resource Allocation’, Hospital and Health Service Review, 08 1977.Google Scholar

30 See Creese, A. L., Darby, S. C., Palmer, S. R. and Patrick, D. L., ‘NHS Priorities and RAWP’, British Medical Journal, 2 (1978), 1,446–7CrossRefGoogle ScholarPubMed.

31 Priorities for Health and Personal Social Services in England, DHSS, HMSO, London, 1976.Google Scholar

32 See Buxton, and Klein, , Allocating Health Resources.Google Scholar

33 See Forbes, J. F., Capital Valuation and the Health Services: A Review of Theory and Practice, Discussion Paper no. 01:79, Health Economics Research Unit, University of Aberdeen, 1979.Google Scholar

34 See Jeffries, M., ‘RAWP and the Oxford Region’, British Medical Journal, 1 (1978), 426–7CrossRefGoogle ScholarPubMed; 495–6; and 638–9.

35 See Yudkin, J. S., ‘Changing Patterns of Resource Allocation in a London Teaching District’, British Medical Journal, 2 (1978), 1,212–5CrossRefGoogle Scholar.

36 See The Lancet, 27 05 1978.Google Scholar

37 See Forsyth, G. and Varley, R., Resource Allocation Subregionally: The Impact in the North Western RHA, mimeograph, 1978.Google Scholar

38 Scottish Health Authorities Revenue Equalisation, Report of the Working Party on Revenue Resource Allocation, Scottish Home and Health Department, HMSO, Edinburgh, 1977.Google Scholar

39 See Forwell, G., ‘A Community Medicine View of the SHARE Report’, Scottish Medical Journal, 23 (1978), 207.CrossRefGoogle ScholarPubMed

40 See House of Commons, Hansard, 18 01 1978, 250:1.Google Scholar

41 Report of the Steering Committee on Resource Allocation in Wales, Welsh Office, HMSO, Cardiff, 1977.Google Scholar

42 The Distribution of Resources to Health Authorities in Wales: Third Report of the Steering Committee, Welsh Office, 1979.Google Scholar

43 Details of sources and calculations are available from the authors.

44 Report of the Steering Committee on Resource Allocation in Wales, para. 5:12.

45 As in Priorities for Health and Personal Social Services in England.

46 Report of the Royal Commission on the National Health Service, Cmnd 7615, HMSO, London, 1979.Google Scholar

47 Ibid. – see Recommendations 113 and 114.