Beyond resource allocation formulae: analysing the role of local health authorities and providers in achieving equity in service delivery

该奖学金的目的是获得知识，以开发和应用一个扩展的资源分配分析框架，该框架解释了地方组织如何确定公平和有效地使用资源。国家卫生保健预算分配给地方组织是实现公平提供卫生保健服务的关键。在英格兰和其他地方，“需要加权按人头计算公式”被用来向国家卫生部门（NHS）内的地方组织分配资源。在英国国民保健制度中，根据反映由年龄、发病率、贫困和当地投入价格决定的需求变化的公式，向包括临床调试小组和提供者在内的地方组织分配了1000亿英镑的预算。地方组织负责支出其预算。例如，一个为非常贫困地区提供服务的机构可能会获得更多资源，但不会将这些资源用于该地区，因为没有要求这样做。因此，政策制定者通过公式设定的目标在多大程度上得到实现，在不同的地方组织之间存在差异。研究将研究在国民保健制度中，地方保健组织如何通过根据需要向其人口提供保健，为公平和有效地使用财政资源做出贡献。特别是，我将分析不同的地方组织的特点，包括供应商如何支付，监管，拥有和组织的影响，在何种程度上的资源分配相匹配的需要，他们的集水区内的人口。我还将模拟替代预算分配的分配效果沿着当地组织特征的变化。我将使用来自政治学和福利经济学的理论框架，我将使用一系列来自计量经济学，生物统计学，流行病学和公共卫生的定量方法。我将使用一个独特的数据集，包括链接的病人记录的使用和成本一般，急性和精神卫生保健超过五years.The研究将集中在英格兰，地方组织正在获得更多的自主权，并在那里的个人层面的行政数据是可用的。它将提高对CCG内资源如何在患者之间分配的理解，这是当地管理人员、医院、全科医生和患者的互动行为的结果。研究结果将为英格兰和其他地区通过资源分配和其他安排（如激励设计）提高医疗支出的公平性和效率提供见解，提高当地组织的绩效。开发的框架和学习和使用的方法可以适应其他设置在未来的研究，并将形成一个长期的研究议程，重点是额外的卫生政策，在其他护理环境，包括初级保健在英格兰，或在低收入国家的卫生系统的发展基础。

The aim of the fellowship is to acquire the kills to develop and apply an extended framework for the analysis of resource allocation that accounts for how local organizations determine the equitable and efficient use of resources.The allocation of national health care budgets to local organisations is key to enabling the equitable provision of health care services. "Need weighted capitation formulae" are used in England and elsewhere to allocate resources to local organizations within the National Health Sector (NHS). In the English NHS a £100 billion budget is allocated to local organizations including Clinical Commissioning Groups (CCGs) and providers, based on a formula that reflects variations in need determined by age, morbidity, deprivation, and local input prices. Local organizations are responsible for spending their budgets. They are held accountable for performance and spending control, but not for how they distribute it. For example, an organisation serving a very deprived area may get more resources, but not spend them there, as there is no requirement to do so. Thus, the extent to which the aim set by policy makers through the formulae is met varies across local organizations.The research will study how in a NHS, local health organizations contribute to an equitable and efficient use of financial resources by delivering care to their populations according to need. In particular, I will analyse the effect of different local organizations' characteristics, including how providers are paid, regulated, owned and organised, on the extent to which the distribution of resources matches the need of populations within their catchment area. I will also simulate the distributional effect of alternative budget allocation along with changes in local organization characteristics. I will use a theoretical framework derived from political science and welfare economics, which I will apply using a range of quantitative methods drawn from econometrics, biostatistics, epidemiology and public health. I will use a unique dataset including linked patient records on the use and cost general, acute and mental health care over five years.The study will focus on England where local organizations are acquiring more autonomy and where linkable individual level administrative data are available. It will improve the understanding of how resources are distributed across patients within CCGs, as a result of the interacting behaviour of local managers, hospitals, GP practices and patients. Results will provide insights for increasing equity and efficiency of healthcare expenditure, in England and elsewhere, through resource allocation and other arrangements, such as incentive design, improving local organizations' performance. The framework developed and the methods learned and used can be adapted to other settings in future research, and will form the base for the development of a longer term research agenda focusing on additional health policies, in other care settings, including primary care in England, or health systems in low-income countries.