Risk adjustment for hospital use using social security data: cross sectional small area analysis

被引:12
作者
Carr-Hill, RA
Jamison, JQ
O'Reilly, D
Stevenson, MR
Reid, J
Merriman, B
机构
[1] Univ York, Ctr Hlth Econ, York YO10 5DD, N Yorkshire, England
[2] Queens Univ Belfast, Inst Clin Sci, Hlth & Social Care Res Unit, Belfast BT12 6BJ, Antrim, North Ireland
[3] Queens Univ Belfast, No Ireland Canc Registry, Belfast, Antrim, North Ireland
来源
BRITISH MEDICAL JOURNAL | 2002年 / 324卷 / 7334期
关键词
D O I
10.1136/bmj.324.7334.390
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting Northern Ireland. Main outcome measure Intensity of use of inpatient services. Results After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.
引用
收藏
页码:390 / 392
页数:5
相关论文
共 28 条
[1]  
[Anonymous], 1976, SHARING RESOURCES HL
[2]  
Armitage P., 1971, STAT METHODS MED RES
[3]  
Batty M., 1976, Urban Modelling-Algorithms, Calibrations, Predictions
[4]  
BRENNAN M, 1996, NO NEED WEIGHT COMMU
[5]   ALLOCATING RESOURCES TO HEALTH AUTHORITIES - DEVELOPMENT OF METHOD FOR SMALL-AREA ANALYSIS OF USE OF INPATIENT SERVICES [J].
CARRHILL, RA ;
SHELDON, TA ;
SMITH, P ;
MARTIN, S ;
PEACOCK, S ;
HARDMAN, G .
BRITISH MEDICAL JOURNAL, 1994, 309 (6961) :1046-1049
[6]   Deprivation indices: Their interpretation and use in relation to health [J].
Carstairs, V .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 1995, 49 :S3-S8
[7]  
*DEP HLTH SOC SEC, 1976, SHAR RES HLTH ENG RE
[8]   Health care system reforms in western European countries: The relevance of health care organization [J].
Elola, J .
INTERNATIONAL JOURNAL OF HEALTH SERVICES, 1996, 26 (02) :239-251
[9]   A NEEDS-BASED METHODOLOGY FOR ALLOCATING HEALTH-CARE RESOURCES IN ONTARIO, CANADA - DEVELOPMENT AND AN APPLICATION [J].
EYLES, J ;
BIRCH, S ;
CHAMBERS, S ;
HURLEY, J ;
HUTCHISON, B .
SOCIAL SCIENCE & MEDICINE, 1991, 33 (04) :489-500
[10]  
GOLDSTEIN H, 1987, MLTILEVEL MODELS ED