Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008

ObjectiveVarious studies find that the share of emergencies in hospital admissions is higher in deprived areas, but both the explanation and policy implications are unclear. We estimate the extent to which this finding is due to a different disease mix in deprived areas, rather than other explanations such as patient behaviour and general practitioner effectiveness.DesignSecondary analysis using English Hospital Episode Statistics data, with disease for elective and emergency admissions in 2008/2009 coded at 186 blocks or 1230 categories and aggregated to lower layer super output area of residence. It is then linked to an appropriate measure of deprivation.Outcome measuresThe difference in the share of emergencies in hospital admissions between communities in the highest and lowest deciles of deprivation; and the percentage of this difference that is explained if areas in the least deprived decile have the same disease mix as those in the most deprived decile.ResultsUsing the finest disease classification scheme (1230 categories), 71% of the higher share of admissions that were emergencies in decile 1 areas relative to decile 10, is explained by the “adverse” case mix (CM) in deprived areas. The remainder reflects the higher relative use of emergency care in deprived areas for the same conditions. Higher incidence of respiratory and circulatory diseases in deprived areas explains about 30% of the CM contribution. Diseases of the digestive system and abdomen have a high relative use of emergency care in deprived areas.ConclusionsThe higher use of emergency care in deprived areas is primarily a symptom of the higher prevalence of diseases which have high national rates of emergency to elective care—especially respiratory diseases—rather than an indication of less effective primary care. Nevertheless, there is a higher share of emergency care in admissions in deprived areas for several diseases, most notably of the digestive system.

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“…[21][22][23][24][25][26][27][28][29] However, these studies do not distinguish emergency and elective treatments.…”

Section: Contextmentioning

confidence: 99%

Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data

2018

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“…The second paper (Cookson et al., 2012) used an expanded dataset with a vector of population, supply and need variables (including disease prevalence collected as part of the English pay-for-performance scheme, the Quality and Outcomes Framework) in an 8-year panel. It applied a revised methodology to identify change in socio-economic equity of several different categories of health care utilisation over time, including inpatient admissions and outpatient visits.…”

Section: Introductionmentioning

confidence: 99%

Hospital admissions for severe mental illness in England: Changes in equity of utilisation at the small area level between 2006 and 2010

White

Gutacker

Jacobs

et al. 2014

Social Science & Medicine

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Severe Mental Illness (SMI) encompasses a range of chronic conditions including schizophrenia, bipolar disorder and psychoses. Patients with SMI often require inpatient psychiatric care. Despite equity being a key objective in the English National Health Service (NHS) and in many other health care systems worldwide, little is known about the socio-economic equity of hospital care utilisation for patients with SMI and how it has changed over time. This analysis seeks to address that gap in the evidence base.We exploit a five-year (2006–2010) panel dataset of admission rates at small area level (n = 162,410). The choice of control variables was informed by a systematic literature search. To assess changes in socio-economic equity of utilisation, OLS-based standardisation was first used to conduct analysis of discrete deprivation groups. Geographical inequity was then illustrated by plotting standardised and crude admission rates at local purchaser level. Lastly, formal statistical tests for changes in socio-economic equity of utilisation were applied to a continuous measure of deprivation using pooled negative binomial regression analysis, adjusting for a range of risk factors.Our results suggest that one additional percentage point of area income deprivation is associated with a 1.5% (p < 0.001) increase in admissions for SMI after controlling for population size, age, sex, prevalence of SMI in the local population, as well as other need and supply factors. This finding is robust to sensitivity analyses, suggesting that a pro-poor inequality in utilisation exists for SMI-related inpatient services. One possible explanation is that the supply or quality of primary, community or social care for people with mental health problems is suboptimal in deprived areas. Although there is some evidence that inequity has reduced over time, the changes are small and not always robust to sensitivity analyses.

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“…Cookson et al (2012) found no change in socioeconomic equity of healthcare use between 2001-2002 and 2008-2009 for elective procedures, and some signs that equity might actually have improved slightly, since inpatient admission rates rose slightly faster in lowincome areas than elsewhere. These results raise some optimism that socioeconomic disparities in healthcare utilisation may be impervious to changes in the provider reimbursement system.…”

Section: Equity Of Carementioning

confidence: 85%

Payment by results for mental health services: economic considerations of case-mix funding

Jacobs¹

2014

Adv. psychiatr. treat

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SummaryAgainst the backdrop of a tight financial climate, a new method of funding mental health services is being rolled out in England's National Health Service. Called payment by results (PbR), it represents a fundamental change to the way providers of psychiatric services are paid for care of patients. The Mental Health Clustering Tool has been developed to capture activity which reflects the relative needs of patients, and cluster costs are being collected by service providers. The ultimate goal is the creation of a national tariff or fixed price for each cluster. This article describes the incentives generated by PbR and gives evidence on PbR in acute physical care services where it has been in operation for a decade, with respect to efficiency, quality, volume of activity, administrative costs, upcoding or gaming, equity of provision, and cross-subsidisation. It explores the challenges for mental health services as PbR is introduced.LEARNING OBJECTIVESUnderstand the difference between retrospective and prospective reimbursement systems and the incentives generated by each financing system.Understand the three key building blocks of PbR: currency, reference costs and tariffs.Consider the evidence on PbR in acute physical care and the implications for mental health services.

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Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent ABSTRACTBackground. This study develops a method for measuring change in socio-economic equity

Cited by 34 publications

References 29 publications

Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data

Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data

Hospital admissions for severe mental illness in England: Changes in equity of utilisation at the small area level between 2006 and 2010

Payment by results for mental health services: economic considerations of case-mix funding

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