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July 01, 2004
How much should we spend on the NHS? Issues and challenges arising from the Wanless Review of future health care spending
Editors: John Appleby, Nancy Devlin, Diane Dawson
ISBN: 1 899040 87 0
Publisher: Office for Health Economics, King's Fund, York University Centre for Health Economics
Price: £12.50
The Wanless Report "Securing Our Future Health" published in 2002 was ground-breaking. It recommended unprecedented spending increases for the NHS of around 7.5% annually in real terms over the next five years. So far, in each subsequent budget the Chancellor has followed these recommendations.
"Securing Our Future Health" is based on some key assumptions, namely that the government can manage the UK's demand for health care encouraging the public to take an active role in preventing ill health; that healthy lifestyles will lead to an overall reduction in the demand for NHS services; productivity in the NHS can improve by 2.5% per annum, and population ageing will primarily affect health care spending at the end of life.
This monograph challenges these and other underlying assumptions, and questions how we can measure progress, and how critical these are to future spending projections. Notably it asks when the models developed by Wanless and his team will be open to public scrutiny, as they are for instance in the US, given its use by government to guide health care expenditure in this country and that Wanless suggested this review exercise be repeated regularly to update and refine the assumptions and knowledge underpinning the spending review.
To order got to OHE
Evaluating the Healthcare System: Effectiveness, Efficiency, and Equity, Third Edition
Authors: Lu Ann Aday, Charles E. Begley, David R. Lairson, Rajesh Balkrishnan
ISBN: 1-56793-222-3
Publisher: Health Administration Press
The book provides an excellent framework for understanding and evaluating healthcare systems and change. By focusing separately on the key system outcomes (effectiveness, efficiency, and equity) and carefully laying out relevant concepts before applying them to major policy issues, the authors provide an unusually thorough treatment of the field of health services research.
-Thomas Rice, Ph.D., Professor of Health Services
University of California at Los Angeles School of Public Health
This upcoming third edition defines and illustrates the measurement and relevance of effectiveness, efficiency, and equity as criteria for evaluating healthcare system performance. Specific examples of the application of health services research in addressing contemporary health policy problems at the national, state, and local level are presented.
This new edition will include a significant amount of new material. In particular, the book will draw upon a growing body of research on the social and economic determinants of population health, and explore the distinct and complementary roles of health services and public health research and policy in improving the health of individuals and communities.
An important healthcare and public health problem area woven throughout the book in demonstrating the effectiveness, efficiency, and equity concepts in the context of these issues is breast and cervical cancer prevention and treatment and related cancer morbidity and mortality outcomes. This example provides a useful opportunity to explore the medical and non-medical predictors of health and healthcare disparities, the role of primary versus secondary prevention, and the utility of the effectiveness, efficiency, and equity benchmarks in guiding the design of state and federal policy to ameliorate disparities.
For more information go to: HAP
Hardbound, approximately 350 pp
Order code: WWW1-2013
Price: $72.00
Table of Contents
- List of Figures
- List of Tables
- Foreword
- Preface
- Acknowledgments
- 1 Introduction to Health Services Research and Policy Analysis
- Appendix 1.1 Healthy People 2010 Leading Health Indicators
- 2 Effectiveness: Concepts and Methods
- 3 Effectiveness: Policy Strategies, Evidence, and Criteria
- 4 Efficiency: Concepts and Methods
- 5 Efficiency: Policy Strategies, Evidence, and Criteria
- 6 Equity: Concepts and Methods
- 7 Equity: Policy Strategies, Evidence, and Criteria
- Appendix 7.1 Highlights of Selected Indicators of Equity of Access to Healthcare
- 8 Integrating Health Services Research and Policy Analysis
- 9 Applying Health Services Research to Policy Analysis
- Index
- About the Authors
The Impact of Ageing on Health Care Expenditures: Impending Crisis or Misguided Concern?
Author: Meena Seshamani
ISBN: 1 899040 97 8
Publisher: Office for Health Economics
Price: £12.50
The Impact of Ageing on Health Care Expenditure: Impending Crisis or Misguided Concern? by Meena Seshamani challenges the long held belief that as the average age of populations increases so health expenditures will rise in direct proportion. Meena Seshamani's original analysis of English data shows that proximity to death is a much stronger predictor of future hospital expenditure than age alone. Additional years of life are lived in health, not disability. Only the last year or two of life significantly increases health care costs per capita, whether at 65 or 75 years of age.
The ageing of national populations has accelerated in the past few decades. It is estimated that 40 to 60% of public spending is sensitive to this changing age structure. Health care providers are concerned with the profound impact this will have on societies and economies.
Traditionally older populations are high users of health care relative to the rest of the population. Per capita expenditure for those aged 65 and over was on average 3.7 times greater than for those aged under 65 (OECD, 1993). It therefore seems logical to expect an ageing population will substantially increase health care costs. Indeed since 1970 GDP expenditure on health care among OECD countries has risen from a population-weighted average of 5.7% to 9.9%, with the UK at 6.9% and the US at 12.9%.
However using age specific expenditures for Hospital and Community Health Services (HCHS) and Family Health Services (FHS) in England and Wales, Meena Seshamani finds "a compression of morbidity" effect : people are living longer, but healthier lives. Her proximity to death findings show:
- age is insignificant in explaining health care expenditure once proximity or time to death is accounted for
- estimated increases in national hospital expenditure due to ageing can be halved
- expenditure effects of increased life span after the age of 65 are small
- most age-related increases in hospital expenditure observed to date are due to the numbers of post WWII baby boomers
For ordering information go to OHE