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Consultation Recommendations

Morbidity and Life Circumstances Additional Analyses Following Consultation NRAC 26 February 2007 Stephen Williams Duncan Buchanan. Consultation Recommendations. Option 1 needs indices: acute, mental health, community, GP prescribing (Table 1)

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Consultation Recommendations

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  1. Morbidity and Life CircumstancesAdditional Analyses Following ConsultationNRAC26 February 2007Stephen WilliamsDuncan Buchanan

  2. Consultation Recommendations • Option 1 needs indices: acute, mental health, community, GP prescribing (Table 1) • Option 2 supplementary variables for each diagnostic group (Table 2) • Further work on Maternity variations • ‘Flat funding’ for 2 diagnostic groups (strong) and 4 diagnostic groups (moderate)

  3. Consultation Recommendations (2) • Ethnic minority needs – no specific needs adjustment • Asylum seekers – no specific needs adjustment • Unmet need – some evidence for circulatory but further work needed.

  4. Consultation Outcome • George Street report • Options 1 & 2 – welcome for greater flexibility but concern over transparency/stability/face validity. • Flat funding – scepticism, especially cancer and non-psychological mental illness, lack of understanding. • Maternity variations – many unsurprised citing rural services and clinical practice

  5. Consultation Outcome (2) • Ethnic minority & asylum seeker needs – broad agreement, data availability issues, translation/interpretation costs • Unmet need – mixed response, defining and measuring unmet need.

  6. Further Work Plan • Update data sources: Needs driver database, cost ratios • Update needs indices and supplementary variables • Update and investigate flat funding results • Analyse maternity variations

  7. Further Work Plan (2) • Effect of ethnic minorities in additional to needs indices & variables • Effect of rurality in addition to needs indices & variables • Prepare unmet need adjustment options

  8. Data Sources • Tribal needs driver datasets obtained • Improved documentation of variables, sources and methods • Needs drivers updated where possible • Cost ratios updated where possible

  9. Figure 1 – Digestive cost ratios

  10. Figure 2 – Stability of coefficients

  11. Figure 2 – Stability of supplementary variables

  12. Regression fits – Updated cost ratios (Table 4) • Comparable results to Tribal • Needs drivers: • Acute, Prescribing ~20-30% • Mental Illness, Learning Dis, Cancer, CotE ~ <15% • Boards + supply • Mental OPs (85%), Acute OPs (51%) • Option 2: <1% improvement

  13. Prediction fits – Year 1 applied to Year 2 (Figure 5)

  14. Needs Indices – options • Option 1 – Indices for acute, mental health, prescribing, community, maternity • Option 2 – Option 1 plus supplementary variables for all diagnostic groups • Alternative Option 1 • Alternative single index

  15. Needs Indices – Alternative Option 1 Single index for Acute, Mental illness, Learning Dis, CotE (e.g. ‘Acute’ index) Specific indices for Prescribing, Community (?)

  16. Flat Funding – Table 6

  17. Flat Funding – Options 1. Flat fund – 0% contribution of needs indices 2. Do not Flat fund – a) x% contribution of needs indices b) try and improve x% Cancer registrations - no improvement in x%

  18. Maternity – Figure 8

  19. Maternity – Figure 9

  20. Maternity – Options 1. Flat fund – 0% contribution of needs indices 2. Do not Flat fund – a) Option 1 index (lone parent h/holds, mean house price b) birth rate (+ rurality ?)

  21. Ethnic Minority needs

  22. Ethnic Minority needs (2) – Figure 12

  23. Ethnic Minority needs (3) Table 8 - After needs indices negative effects: • Cancer, Injuries • Learning Difficulties, Dementia • Non-psych & other Mental illness, • Substance misuse, etc => Lower utilisation rates (unmet need ?)

  24. Rurality needs – Figure 13

  25. Rurality needs (2) Table 9 - After needs indices negative effects: • Acute outpats, Circulatory, Digestive, Other • Mental health drugs • Lower utilisation rates (unmet need ?) Positive effects: Learning Dis, Maternity

  26. Unmet Need - deprivation • Shortfall method • Variations method • Comparison with disease prevalence

  27. Unmet Need - shortfall utilisation shortfall High deprivation

  28. Unmet Need – Deprivation (Table 10) Evidence of shortfall: • Circulatory, Acute – other • Dementia, Mental illness outpatients Evidence of excess: • Injuries • Prescribing – CV, mental health, gastro, other

  29. Board A Unmet Need - Variations utilisation Board B Board C Needs index

  30. Unmet Need – Deprivation (Table 11) Evidence of Board variations: • Acute OP, Circulatory, Injuries, Respiratory Other • Dementia, Mental illness outpatients • Care of the elderly • Maternity • All Prescribing

  31. Unmet Need – Disease Prevalence Scottish Health Survey 2003 • Sample size 11,000 + • Postcodes • Ethnicity • Long standing illness question • ICD coded

  32. Unmet Need – Cancer (Figure 14)

  33. Unmet Need – Circulatory (Figure 14)

  34. Recommendations Option 1 vs Option 2 ? Option 1 vs simpler alternative ? Flat funding or not ? Maternity ? Ethnic minorities/rurality ? Unmet need ?

  35. Recommendations Option 1 vs Option 2 ? Option 1 vs simpler alternative ? Flat funding or no flat funding ? Maternity ? Use simple index Ethnic minorities/rurality ? See unmet need Unmet need ? Prepare optional gradients for specific diagnostic groups

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