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Br J Psychiatry. 2019 Aug 8:1-7. doi: 10.1192/bjp.2019.185. [Epub ahead of print]

Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level.

Author information

1
Research Fellow, Health Organisation,Policy and Economics,University of Manchester,UK.
2
Senior Analytical Lead, Analysis and Insight for Finance,NHS England,UK.
3
Lead Analysis (forecasting), Analytical Insight Resource Unit,NHS England,UK.
4
Senior Manager, Operations & Information Directorate,NHS England,UK.
5
Senior Analytical Manager, Analysis and Insight for Finance,NHS England,UK.
6
Analysis and Insight for Finance,NHS England,UK.
7
Analyst, Analysis and Insight for Finance,NHS England,UK.
8
Professor of Health Economics, Health Organisation,Policy and Economics,University of Manchester,UK; andProfessorial Research Fellow, Melbourne Institute for Applied Economic and Social Research,University of Melbourne,Australia.
9
Head of Analysis and Insight for Finance,NHS England,UK.

Abstract

BACKGROUND:

Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.AimsTo produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England.

METHOD:

We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula.

RESULTS:

Higher costs were associated with: being 30-50 years old, compared with 20-24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.

CONCLUSIONS:

The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.Declaration of interestNone.

KEYWORDS:

Mental health; cost; need; weighted capitation

PMID:
31391127
DOI:
10.1192/bjp.2019.185

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