PPT 4 -

 A fundamental requirement of government at all levels—national and local—is to distribute the limited funds that it wishes to spend on particular public services between geographical areas or institutions, which are effectively competitors for such funds.  Increasing use is now being made of capitation methods for such purposes, in which a standard estimate of expected expenditure is attached to a citizen with given characteristics.

 Statistical methods are playing an important role in determining such capitation/budgets, but they give rise to profound methodological problems.  Severe limitations of government data mean that small area data are used as the unit of observation, giving rise to considerable complexity in the model to be estimated.  As a result, a range of methodologies including two- stage least squares and multilevel modelling methods are deployed.  suggestions for an approach which would represent an improvement on current capitation methods, but which would require data on individuals rather than on small areas could solve these issues, what do you think?

 Two stage least squares is an instrumental variables estimation technique. This has been used to estimate the correlation between the health needs of people in a given geographical area of the UK and anticipated expected health expenditure.

 What do they mean by limitation in this method of mixed economy of care?  How do you think that central government can judge how budgets should be distributed on such small scale case studies?  What do they mean by given characteristics?

 Mixed economy of care is the provision of care by a range of service providers.  Instead of services being solely provided by the NHS and social services (the public sector), some services are commissioned from the independent and voluntary sectors.

 Central government provides the money to the local councils through the Standards Spending Assessment (SSA) formula, based on the population profile of the area, including such factors as: › The number of older people › Types of housing › Single parents › Ethic groupings › Population density Local councils also raise money from › local council tax › Fees & charges for their services

 In Britain, the amount of money that the government calculates a local council needs to spend on providing a particular service, and which they give to the council for this purpose.

1. What are the origins of the statutory care sector? 2. List what the four different care sectors are and give examples.

1. The four different care sectors are private, statutory, voluntary and informal care. 2. The welfare state of the 1940’s. this was the beginning of an organisation, accessible and wide-ranging heath and welfare system for all citizens.

1. Explain the advantages of developing greater partnership between agencies within health care. Reference ‘mixed economy of care’. 2. Indentify the effects of the introduction of an internal market on the care system.

1. Maximise resources effectively 2. Minimise overlapping and duplication of services 3. Services are needs led, instead of budget led 4. Improved quality of provision 5. Effective communication between agencies 6. Financial resources are used effectively 7. Creates a range and variety of resources 8. Creates good sound networking between agencies 9. Multidisciplinary approach (Patients with colorectal, gastric, and pancreatic malignancies often have a complex array of medical issues and require a combination of surgery, chemotherapy, radiation therapy, therapeutic endoscopy and other treatments. Recognising that a team approach is the most beneficial way to manage cancer, many organisation have developed a multidisciplinary program for treating patients).

1. Using your notes – explain the difference between primary, secondary and tertiary health care 2. What is the main example of the statutory health care sector? 3. Give a definition of social care 4. What is SSA and explain why you think central government carries out this process?

 Once government has assessed the standard of spending to be directed at specific health care facilities in your Local authority (LA), the LA will also raise funds from local council tax.  Local councils are monitored on performance and spending by government and by the Commission for Social Care Inspection (CSCI)  Some services relating to education and children eg. child minding, nursery school provision are monitored by the Office for Standards in education (OFSTED)

 Journal of the Royal Statistical Society: Series A (Statistics in Society)  Volume 164, Issue 2, 2001, Pages: 217– 257, Peter C. Smith, Nigel Rice and Roy Carr-Hill  Article first published online : 6 JAN 2002, DOI: / X.00200