Transcript RESOURCE ALLOCATION & WEIGHTED CAPITATION

RESOURCE ALLOCATION AND
TARGETING SOCIAL NEED
NORTHERN IRELAND HEALTH
AND PERSONAL SOCIAL
SERVICES (HPSS)
MARTIN MAYOCK
INFORMATION & ANALYSIS UNIT
DHSSPS
INTRODUCTION
• RESOURCE ALLOCATION IN NI HPSS – STRUCTURE
AND BACKGROUND
• WEIGHTED CAPITATION PRINCIPLES
• MEASUREMENT OF SOCIAL NEED
• NEEDS SENSITIVITY ANALYSIS
• SUB-BOARD APPLICATION OF FORMULA
• CURRENT RESEARCH
NI HPSS – STRUCTURE AND
FUNDING FLOWS
THE DEPARTMENT
4 HEALTH AND SOCIAL
SERVICES BOARDS
11 TRUST LOCALITY
AREAS
RESOURCE ALLOCATION IN NI
HPSS - BACKGROUND
• HISTORICAL EXPENDITURE
– PERPETUATES EXISTING INEQUALITIES
• POPULATION BASED METHODS
– USED IN N. IRELAND SINCE 1978
• CAPITATION FORMULA REVIEW GROUP
– ESTABLISHED 1994
– IMPROVE ON EXISTING FORMULA
– FOURTH REPORT DUE MAY 2004
STRUCTURE OF FORMULA
• SEPARATE FORMULA FOR EACH OF NINE
PROGRAMMES OF CARE (PoCs)
EXAMPLES
– ACUTE HOSPITAL SERVICES
– ELDERLY CARE
– MENTAL HEALTH
• FORMULAE ARE SENSITIVE TO THE NEEDS OF
EACH CLIENT GROUP
WEIGHTED CAPITATION PRINCIPLES
• POPULATION SIZE
• AGE/GENDER ADJUSTMENT
• ADDITIONAL NEEDS ADJUSTMENT
• OTHER ADJUSTMENTS
– RURAL COSTS
– INCOME ADJUSTMENT
WEIGHTED CAPITATION
- POPULATION
• POPULATION SIZE IS MOST IMPORTANT
ELEMENT
CRUDE POPULATION PERCENTAGES (2002)
–
–
–
–
EHSSB
NHSSB
SHSSB
WHSSB
39%
25%
19%
17%
• POPULATION SOURCE
– MID-YEAR ESTIMATES (NISRA)
WEIGHTED CAPITATION
- AGE/GENDER
• VERY YOUNG AND THE ELDERLY HAVE MOST
NEED FOR SERVICES
• MALES AND FEMALES ALSO HAVE DIFFERENT
SERVICE NEEDS
• THIS NEED WILL DIFFER DEPENDING ON
SERVICE TYPE
• MAJOR COSTING EXERCISE CARRIED OUT BY
BOARDS
• RESULTS USED TO INCREASE/DECREASE
CRUDE POPULATIONS IN EACH PROGRAMME
AGE/GENDER COSTS – ALL POCS
Male
Female
Total
Expenditure (£)
8,000
6,000
4,000
2,000
0-4
20-24
40-44
Age Bands
60-64
80-84
WEIGHTED CAPITATION
- ADDITIONAL NEEDS
• IMPORTANT TO TAKE DIFFERENT ILLNESS
LEVELS INTO ACCOUNT
• FACTORS ASSOCIATED WITH INCREASED
ILLNESS
–
–
–
–
DEPRIVATION RELATED
LIVING CIRCUMSTANCES
HEALTH STATUS
RURAL/URBAN LIVING
• SERVICE USE AS A PROXY FOR NEED
MEASUREMENT OF NEED
- SMALL AREA ANALYSIS
• DATA REQUIREMENTS
–
–
–
–
–
MEASURES OF UTILISATION/ACTIVITY
COST DATA
SOCIO-ECONOMIC DATA
HEALTH STATUS DATA
RURALITY DATA
• ALL DATA REQUIRE A GEOGRAPHIC
IDENTIFIER
SMALL AREA ANALYSIS
-SIMPLIFIED MODEL
DEPRIVATION
FACTORS
HEALTH STATUS
FACTORS
RURAL NEEDS
FACTORS
NEED
ADDITIONAL NEEDS FORMULAE
- EXAMPLES
• ACUTE SERVICES
–
–
–
–
–
SMR (ALL AGES)
ELDERLY LIVING ALONE
INCOME SUPPORT
FAMILY CREDIT
LOW BIRTHWEIGHT
• FAMILY AND CHILD CARE
– LONE PARENTS ON INCOME SUPPORT
– CHILDREN WITH A LONG-TERM ILLNESS
– CHILDREN IN SOCIAL RENTED HOUSING
IMPACT OF NEEDS AT WARD LEVEL
- TOP 5 DEPRIVED WARDS
ELECTORAL
WARD
LGD
AGE/GENDER
WEIGHTED
SHARE (%)
AGE/GENDER
& NEEDS
WEIGHTED
SHARE (%)
CHANGE
IN SHARE
(%)
SHANTALLOW
EAST
DERRY
0.12
0.27
127.6
COLLIN GLEN
LISBURN
0.43
0.74
73.8
UPPER
SPRINGFIELD
BELFAST
0.29
0.48
62.5
ST PETERS
DERRY
0.10
0.16
58.9
ARDOYNE
BELFAST
0.37
0.56
49.7
UNMET NEED
• FORMULA ASSUMES UTILISATION IS AN
ADEQUATE PROXY FOR NEED
• UNDER UTILISATION AND HENCE UNMET NEEDS
– DEPRIVED VERSUS AFFLUENT COMMUNITIES
– RURAL VERSUS URBAN POPULATIONS
• TEST DEVELOPED TO DETECT UNMET NEED AND
CORRECT (STATISTICALLY) IF REQUIRED
SUB-BOARD FORMULA USE
• GUIDELINES PRODUCED AS PART OF CFRG REVIEW
• DECREASED ACCUARACY WHEN APPLYING FORMULA
TO SMALL POPULATION UNITS
• CONSIDERATION SHOULD BE GIVEN TO LOCAL
FACTORS
– ETHNIC GROUPS/TRAVELLERS
– LONG-TERM INSTITUTIONAL CARE
– DRUG MISUSE
• FORMULA SHOULD INFORM ALLOCATIONS NOT
RIGIDLY SET THEM
CURRENT CFRG RESEARCH
• LEARNING DISABILITY ADMINISTRATIVE
PREVALENCE STUDY
• PHYSICAL AND SENSORY DISABILITY NEEDS STUDY
• REFINED MENTAL HEALTH NEEDS INDEX
• UPDATED FAMILY AND CHILD CARE NEEDS STUDY
• UNMET NEED
• COSTS ARISING FROM ECONOMIES/DISECONOMIES
OF SCALE