The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study.
The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study.
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DOI：
10.1136/bmj.g3231
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发表时间：
2014-05-27
期刊：
影响因子：
--
通讯作者：
Whitehead M
中科院分区：
文献类型：
--
作者：
Barr B;Bambra C;Whitehead M
目的探讨与富裕地区相比，在英格兰贫困地区更大程度地增加国家卫生服务经费的政策是否减少了适合医疗保健的死亡率的地理不平等。设计纵向生态学研究。在英格兰设置了324个较低级别的地方当局，根据他们的基线贫困水平进行分类。2001年至2011年英国国民保健服务资源分配政策导致分配给当地地区的国民保健服务资金的干预差异趋势。主要结果衡量英格兰地方当局地区被认为适合医疗保健的原因导致的死亡率趋势。使用多元回归，我们估计了与在这些地区分配额外的NHS资源相关的死亡率的降低。结果从2001年到2011年，贫困地区国民保健服务资源的增加缩小了贫困地区和富裕地区之间的差距，男性死亡率为每10万 000人口35例死亡(95%可信区间27-42)，女性死亡率为每10万 000人口16例死亡(10-21例)。这解释了在这段时间内，受医疗保健影响的死亡率绝对不平等总降幅的85%。分配给贫困地区的资源每增加1000万GB，男性每10万 减少4例(3.1%至4.9%)，女性每10万 减少1.8%(1.1%至2.4%)。在更富裕的地区，NHS资源的绝对增加与医疗保健死亡率的改善之间的关联并不显著。结论在2001-2011年间，NHS的健康不平等政策，即与较富裕地区相比，增加分配给贫困地区的资源比例，这一政策与减少绝对健康不平等有关，这些绝对健康不平等是由医疗保健引起的。放弃这项政策可能会扩大不平等。
Objective To investigate whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England compared with more affluent areas led to a reduction in geographical inequalities in mortality amenable to healthcare. Design Longitudinal ecological study. Setting 324 lower tier local authorities in England, classified by their baseline level of deprivation. Intervention Differential trends in NHS funds allocated to local areas resulting from the NHS resource allocation policy in England between 2001 and 2011. Main outcome measure Trends in mortality from causes considered amenable to healthcare in local authority areas in England. Using multivariate regression, we estimated the reduction in mortality that was associated with the allocation of additional NHS resources in these areas. Results Between 2001 and 2011 the increase in NHS resources to deprived areas accounted for a reduction in the gap between deprived and affluent areas in male mortality amenable to healthcare of 35 deaths per 100 000 population (95% confidence interval 27 to 42) and female mortality of 16 deaths per 100 000 (10 to 21). This explained 85% of the total reduction of absolute inequality in mortality amenable to healthcare during this time. Each additional £10m of resources allocated to deprived areas was associated with a reduction in 4 deaths in males per 100 000 (3.1 to 4.9) and 1.8 deaths in females per 100 000 (1.1 to 2.4). The association between absolute increases in NHS resources and improvements in mortality amenable to healthcare in more affluent areas was not significant. Conclusion Between 2001 and 2011, the NHS health inequalities policy of increasing the proportion of resources allocated to deprived areas compared with more affluent areas was associated with a reduction in absolute health inequalities from causes amenable to healthcare. Dropping this policy may widen inequalities.
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