Setting health care capitations through diagnosis-based risk adjustment: a suitable model for the English NHS?

摘要: Abstract The English system of health resource allocation has been described as the apotheosis area-level approach to setting care capitations. However, recent policy developments have changed scale at which commissioning decisions are made (and budgets allocated) with important implications for allocation. Doubts concerning legitimacy applying area-based formulae used distribute resources between Primary Care Trusts (PCTs) much smaller required by Practice Based Commissioning (PBC) led Department Health (DH) introduce a new budgets. To this end, practice-level allocations acute services now calculated using diagnosis-based capitation model kind in United States and several other systems competitive social insurance. Coalition Government proposed that these directly allocated GP ‘consortia’, bodies NHS. This paper questions whether is an appropriate development major objective promote equal opportunity access needs. chief reservation raised circularity perpetuation bias, concern being existing social, demographic geographical bias use will be reinforced through historic utilisation data. Demonstrating there legitimate reasons suspect case, poses question internationally should more openly address key limitations empirical methods select risk adjusters on basis patterns service utilisation.