Ways of seeing: explaining variations in use of acute hospital services.
BACKGROUND
In the US Medicare programme, hospitals are paid directly by activity. To provide incentives for efficiency, the US Federal Government has sought objective measures of inpatients' need for resources. In the UK National Health Service, resources are allocated for acute hospital services as part of a global budget to purchasers, who then contract with hospitals. To provide equity in resource allocation, the Department of Health in England, has sought objective measures of populations' need for resources.


METHODS
Examination of policy and technology that has used variations in utilization of resources to derive objective measures of efficiency and equity.


RESULTS
The technology of developing empirical measures of resources needed by patients has lacked information on outcomes, which is vital for measures of efficiency. The technology of developing empirical measures of resources needed by populations has relied on aggregate data. Analyses of specific procedures and conditions consistently find that these variations are explained by differences in medical practice and not by need.


CONCLUSIONS
There is scope for multidisciplinary research to explain small area variations for specific procedures and conditions in resources used by populations. It seems unlikely, however, that governments will be interested in findings from this research.
Bevan
G
G
Department of Social Medicine, University of Bristol, UK.
D015276:Health Care Rationing / Q000706:statistics & numerical data; D006291:Health Policy; D006295:Health Resources / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006761:Hospitals; D006801:Humans; D006278:Medicare; D013222:State Medicine; D006113:United Kingdom; D014481:United States