TY - JOUR
KW - Mental Health
KW - Cost
KW - need
KW - weighted capitation
AU - L. Anselmi
AU - A. Everton
AU - R. Shaw
AU - W. Suzuki
AU - J. Burrows
AU - R. Weir
AU - R. Tatarek-Gintowt
AU - M. Sutton
AU - S. Lorrimer
A1 - 
AB - BACKGROUND: Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need. AIMS: To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England. METHOD: We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula. RESULTS: Higher costs were associated with: being 30-50 years old, compared with 20-24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost. CONCLUSIONS: The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
AD - Research Fellow, Health Organisation, Policy and Economics, University of Manchester, UK.; Senior Analytical Manager, Analysis and Insight for Finance, NHS England, UK.; Senior Analytical Lead, Analysis and Insight for Finance, NHS England, UK.; Lead Analysis (forecasting), Analytical Insight Resource Unit, NHS England, UK.; Senior Manager, Operations & Information Directorate, NHS England, UK.; Senior Analytical Manager, Analysis and Insight for Finance, NHS England, UK.; Analysis and Insight for Finance, NHS England, UK.; Analyst, Analysis and Insight for Finance, NHS England, UK.; Professor of Health Economics, Health Organisation, Policy and Economics, University of Manchester, UK; and Professorial Research Fellow, Melbourne Institute for Applied Economic and Social Research, University of Melbourne, Australia.; Head of Analysis and Insight for Finance, NHS England, UK.
BT - The British journal of psychiatry : the journal of mental science
C5 - Financing & Sustainability; Healthcare Disparities
CP - 6
DO - 10.1192/bjp.2019.185
IS - 6
JF - The British journal of psychiatry : the journal of mental science
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need. AIMS: To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England. METHOD: We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula. RESULTS: Higher costs were associated with: being 30-50 years old, compared with 20-24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost. CONCLUSIONS: The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
PY - 2020
SN - 1472-1465; 0007-1250; 0007-1250
SP - 338
EP - 344
EP - 
T1 - Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level
T2 - The British journal of psychiatry : the journal of mental science
TI - Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level
U1 - Financing & Sustainability; Healthcare Disparities
U2 - 31391127
U3 - 10.1192/bjp.2019.185
VL - 216
VO - 1472-1465; 0007-1250; 0007-1250
Y1 - 2020
Y2 - Jun
ER -