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RESOURCE ALLOCATION AND TARGETING SOCIAL NEED

RESOURCE ALLOCATION AND TARGETING SOCIAL NEED. NORTHERN IRELAND HEALTH AND PERSONAL SOCIAL SERVICES (HPSS). MARTIN MAYOCK INFORMATION & ANALYSIS UNIT DHSSPS. INTRODUCTION. RESOURCE ALLOCATION IN NI HPSS – STRUCTURE AND BACKGROUND WEIGHTED CAPITATION PRINCIPLES MEASUREMENT OF SOCIAL NEED

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RESOURCE ALLOCATION AND TARGETING SOCIAL NEED

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  1. RESOURCE ALLOCATION AND TARGETING SOCIAL NEED NORTHERN IRELAND HEALTH AND PERSONAL SOCIAL SERVICES (HPSS) MARTIN MAYOCK INFORMATION & ANALYSIS UNIT DHSSPS

  2. INTRODUCTION • RESOURCE ALLOCATION IN NI HPSS – STRUCTURE AND BACKGROUND • WEIGHTED CAPITATION PRINCIPLES • MEASUREMENT OF SOCIAL NEED • NEEDS SENSITIVITY ANALYSIS • SUB-BOARD APPLICATION OF FORMULA • CURRENT RESEARCH

  3. NI HPSS – STRUCTURE AND FUNDING FLOWS THE DEPARTMENT 4 HEALTH AND SOCIAL SERVICES BOARDS 11 TRUST LOCALITY AREAS

  4. RESOURCE ALLOCATION IN NI HPSS - BACKGROUND • HISTORICAL EXPENDITURE • PERPETUATES EXISTING INEQUALITIES • POPULATION BASED METHODS • USED IN N. IRELAND SINCE 1978 • CAPITATION FORMULA REVIEW GROUP • ESTABLISHED 1994 • IMPROVE ON EXISTING FORMULA • FOURTH REPORT DUE MAY 2004

  5. STRUCTURE OF FORMULA • SEPARATE FORMULA FOR EACH OF NINE PROGRAMMES OF CARE (PoCs) EXAMPLES • ACUTE HOSPITAL SERVICES • ELDERLY CARE • MENTAL HEALTH • FORMULAE ARE SENSITIVE TO THE NEEDS OF EACH CLIENT GROUP

  6. WEIGHTED CAPITATION - PRINCIPLES • POPULATION SIZE • AGE/GENDER ADJUSTMENT • ADDITIONAL NEEDS ADJUSTMENT • OTHER ADJUSTMENTS • RURAL COSTS • INCOME ADJUSTMENT

  7. WEIGHTED CAPITATION- POPULATION • POPULATION SIZE IS MOST IMPORTANT ELEMENT CRUDE POPULATION PERCENTAGES (2002) • EHSSB 39% • NHSSB 25% • SHSSB 19% • WHSSB 17% • POPULATION SOURCE • MID-YEAR ESTIMATES (NISRA)

  8. WEIGHTED CAPITATION- AGE/GENDER • VERY YOUNG AND THE ELDERLY HAVE MOST NEED FOR SERVICES • MALES AND FEMALES ALSO HAVE DIFFERENT SERVICE NEEDS • THIS NEED WILL DIFFER DEPENDING ON SERVICE TYPE • MAJOR COSTING EXERCISE CARRIED OUT BY BOARDS • RESULTS USED TO INCREASE/DECREASE CRUDE POPULATIONS IN EACH PROGRAMME

  9. AGE/GENDER COSTS – ALL POCS

  10. WEIGHTED CAPITATION- ADDITIONAL NEEDS • IMPORTANT TO TAKE DIFFERENT ILLNESS LEVELS INTO ACCOUNT • FACTORS ASSOCIATED WITH INCREASED ILLNESS • DEPRIVATION RELATED • LIVING CIRCUMSTANCES • HEALTH STATUS • RURAL/URBAN LIVING • SERVICE USE AS A PROXY FOR NEED

  11. MEASUREMENT OF NEED - SMALL AREA ANALYSIS • DATA REQUIREMENTS • MEASURES OF UTILISATION/ACTIVITY • COST DATA • SOCIO-ECONOMIC DATA • HEALTH STATUS DATA • RURALITY DATA • ALL DATA REQUIRE A GEOGRAPHIC IDENTIFIER

  12. SMALL AREA ANALYSIS-SIMPLIFIED MODEL DEPRIVATION FACTORS NEED HEALTH STATUS FACTORS RURAL NEEDS FACTORS

  13. ADDITIONAL NEEDS FORMULAE - EXAMPLES • ACUTE SERVICES • SMR (ALL AGES) • ELDERLY LIVING ALONE • INCOME SUPPORT • FAMILY CREDIT • LOW BIRTHWEIGHT • FAMILY AND CHILD CARE • LONE PARENTS ON INCOME SUPPORT • CHILDREN WITH A LONG-TERM ILLNESS • CHILDREN IN SOCIAL RENTED HOUSING

  14. IMPACT OF NEEDS AT WARD LEVEL- TOP 5 DEPRIVED WARDS

  15. UNMET NEED • FORMULA ASSUMES UTILISATION IS AN ADEQUATE PROXY FOR NEED • UNDER UTILISATION AND HENCE UNMET NEEDS • DEPRIVED VERSUS AFFLUENT COMMUNITIES • RURAL VERSUS URBAN POPULATIONS • TEST DEVELOPED TO DETECT UNMET NEED AND CORRECT (STATISTICALLY) IF REQUIRED

  16. SUB-BOARD FORMULA USE • GUIDELINES PRODUCED AS PART OF CFRG REVIEW • DECREASED ACCUARACY WHEN APPLYING FORMULA TO SMALL POPULATION UNITS • CONSIDERATION SHOULD BE GIVEN TO LOCAL FACTORS • ETHNIC GROUPS/TRAVELLERS • LONG-TERM INSTITUTIONAL CARE • DRUG MISUSE • FORMULA SHOULD INFORM ALLOCATIONS NOT RIGIDLY SET THEM

  17. CURRENT CFRG RESEARCH • LEARNING DISABILITY ADMINISTRATIVE PREVALENCE STUDY • PHYSICAL AND SENSORY DISABILITY NEEDS STUDY • REFINED MENTAL HEALTH NEEDS INDEX • UPDATED FAMILY AND CHILD CARE NEEDS STUDY • UNMET NEED • COSTS ARISING FROM ECONOMIES/DISECONOMIES OF SCALE

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