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dc.contributor.advisorFlowerdew, Robin F.
dc.contributor.authorWhite, Christopher P.
dc.description.abstractThe central hypothesis of this study was that the allocation system for NHS hospital and community health services between 1997 and 2003 was not meeting key principles of compensating for differences in the need for services and unavoidable costs. The review and analyses in this study indicate that the underpinning assumptions used when formulating the need adjustment were not robust and that this led to the selection of inappropriate proxies for need. In addition it is concluded that the age adjustment underestimated the costs of elderly care. This study has concluded that the pay adjustment, which was the largest in the formula, did not reflect actual unavoidable differences in cost because the Warwick studies that were used to set the adjustment ignored the monopsonistic nature of the NHS. As a consequence the pay adjustment was based on the assumption that NHS salaries should be related to local salaries. This study identified unavoidable additional costs of providing healthcare in rural areas. These findings were consistent with other comprehensive studies on healthcare costs in Scotland, Wales and Northern Ireland. This study concludes that the exclusion of a market forces adjustment for rurality was inconsistent with all other comparable allocation formulae in the Home Countries. The absence of a rurality adjustment resulted in rural areas receiving a lower proportion of NHS funding than was justified and this is referred to as the Inverse Share Law. This study concludes that the central hypothesis was correct and that a rurality adjustment was justified, but that the principal determinant of service quality was an adequate focus on efficiency.en_US
dc.publisherUniversity of St Andrews
dc.relationWarren, M., (2000), A chronology of state medicine, public health, welfare and related services in Britain: 1066-1999 ISBN 1900273063
dc.relationWhite, C. P., Halton, P., Flowerdew, R., (1999), Country strife: rural areas will continue to receive a raw deal unless funding formulas are changed, Health Service Journal, 20-21,12 Augusten_US
dc.relationWhite, C. P., Halton, P., Flowerdew, R., (2000), The Scottish lesson in healthcare funding, Parliamentary Brief, Health Special, 6, 4, 22-25en_US
dc.relationWhite, C. P., Flowerdew, R., (1999), Rural health formula revisited, Public Finance, 26-28,10 Decemberen_US
dc.relationWhite, C. P., (2001), Avoiding the postcode lottery, Overview, 35, 46-47en_US
dc.relationAsthana, S., Gibson, A., Moon, G., Dicker, J., Brigham, P., (2002), Rural areas may need more health care resources in England too, British Medical Journal, 324en_US
dc.relationBanyard, R., (30 January 1997), Out in the field, Health Service Journal, 30-31en_US
dc.relationBentham, G. , Haynes, R., (1986), A Raw Deal in Remoter Areas?, Family Practitioner Services, 13, 5, 84-87en_US
dc.relationCarr-Hill, R., Rice, N., (1995), Is enumeration district level an improvement on ward level analysis in studies of deprivation and health? Journal of Epidemiology and Community Health, 49, S28- 29en_US
dc.relationCloke, P. and Edwards, Rurality in England and Wales, (1981), A Replication of the 1971 index, Regional Studies, 20(4), Cambridge University Press)en_US
dc.relationCraig, J., (1988), Local Authority urban-rural indicators compared, Population Trends, 51, 30-38en_US
dc.relationDepartment of Health, RAWP 1, History of staff market forces factor,
dc.relationHealth Authority Revenue Allocations Exposition Book 2000/2001, (1999),Resource Allocation and Funding Team, Finance and Performance Directorate NHS Executiveen_US
dc.relationMHA and Operational Research in Health Ltd, (1997), Study of Costs of Providing Health Services in Rural Areas, Progress Report to Resource Allocation Group Volume 1en_US
dc.relationScottish Executive Health Department, (1999), Fair shares for all, Report of the National Review of Resource Allocation for the NHS in Scotland, J Arbuthnott, Principal and Vice-Chancellor of Strathclyde Universityen_US
dc.relationTudor Hart, J., (1971), The inverse care law, Lancet, 405-412en_US
dc.rightsCreative Commons Attribution 3.0 Unported
dc.subjectMarket forces factoren_US
dc.subject.lcshNational Health Service (Great Britain)--Financeen
dc.subject.lcshRural health services--Great Britain--Financeen
dc.subject.lcshMedical care--Great Britain--Financeen
dc.subject.lcshMedical economics--Great Britainen
dc.titleNHS resource allocation 1997 to 2003 with particular reference to the impact on rural areasen_US
dc.type.qualificationnamePhD Doctor of Philosophyen_US
dc.publisher.institutionThe University of St Andrewsen_US

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