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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) - PowerPoint PPT Presentation
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Morbidity and Life Circumstances
Additional Analyses Following Consultation
NRAC26 February 2007
Stephen WilliamsDuncan Buchanan
• 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)
Consultation Recommendations
• Ethnic minority needs – no specific needs adjustment
• Asylum seekers – no specific needs adjustment
• Unmet need – some evidence for circulatory but further work needed.
Consultation Recommendations (2)
• 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
Consultation Outcome
• Ethnic minority & asylum seeker needs – broad agreement, data availability issues, translation/interpretation costs
• Unmet need – mixed response, defining and measuring unmet need.
Consultation Outcome (2)
• Update data sources: Needs driver database, cost ratios
• Update needs indices and supplementary variables
• Update and investigate flat funding results
• Analyse maternity variations
Further Work Plan
• Effect of ethnic minorities in additional to needs indices & variables
• Effect of rurality in addition to needs indices & variables
• Prepare unmet need adjustment options
Further Work Plan (2)
• Tribal needs driver datasets obtained
• Improved documentation of variables, sources and methods
• Needs drivers updated where possible
• Cost ratios updated where possible
Data Sources
Figure 1 – Digestive cost ratios
0.00 0.50 1.00 1.50 2.00 2.50 3.00
ACU_DIGESTIVE (rate)
0.00
0.50
1.00
1.50
2.00
2.50
3.00
rati
o_D
IG_
06
Figure 2 – Stability of coefficients
Option 1: Acute Index
-0.1
-0.05
0
0.05
0.1
0.15
0.2
Figure 2 – Stability of supplementary variables
Acute Supplementary Variables
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
• 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
Regression fits – Updated cost ratios (Table 4)
Prediction fits – Year 1 applied to Year 2 (Figure 5)
Predicted Cost Ratios vs Actual: Mental & Care of Elderly
0%
10%
20%
30%
40%
50%
60%
70%
Care ofElderly
Learning Dementia Non Psych MentalOther
MentalOutpats
Schiz SubstanceMisuse
R2
Index Supplementary Psuedo Arbuthnott Index (In sample)
86.3
a. Option 1 – Indices for acute, mental health, prescribing, community, maternity
b. Option 2 – Option 1 plus supplementary variables for all diagnostic groups
c. Alternative Option 1
d. Alternative single index
Needs Indices – options
Single index for Acute, Mental illness, Learning Dis, CotE (e.g. ‘Acute’ index)
Specific indices for Prescribing, Community (?)
Needs Indices – Alternative Option 1
Flat Funding – Table 6R squared Contribution of Health Boards and Supply
Contribution of Dependent Specific Needs Drivers Low (<10%)
Moderate (10% - 30%) High (>30%)
Low (<10%)
Cancer, Dementia, Learning Difficulties, Non-Psychological, Mental Other, Schizophrenia, Infections
Mental Outpatients, Maternity
Moderate (10% - 30%)
Heart, Injuries, Muscular & Joint Disease, Schizophrenia, Substance Misuse
Acute Outpatients, Cardiovascular
High (>30%)
Digestive, Other Acute, Respiratory, Central Nervous System, Gastrointestinal, Other Prescribing
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%
Flat Funding – Options
Maternity – Figure 8
Large urban Other urban Accessible small towns
Remote small towns
Accessible rural
Remote rural
SEURC 6 fold
0.00
2.00
4.00
6.00
8.00
10.00
12.00
ma
t_a
vg
_lo
s
S02001176S02001132
S02000136
S02000222
S02000415
S02000215S02000583
S02000432S02000440
S02001130
S02000436
S02000944
S02000617
S02000424
S02000692
S02000332
S02001152
S02000473
S02000946
Maternity – Figure 9
Large urban Other urban Accessible small towns
Remote small towns
Accessible rural
Remote rural
SEURC 6 fold
0.00
0.05
0.10
0.15
0.20
0.25
0.30b
irth
_ra
te
S02000069S02000744
S02000187
S02001111
S02000252
S02000765S02000989S02000900
S02000994
S02000493
S02000438
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 ?)
Maternity – Options
Ethnic Minority needs
<0.5% 0.5-1% 1-2% 2-4% 4%or >
Proportion in Black & Ethnic Minorities
0
100
200
300
400
500
Fre
qu
en
cy
Proportion in Black & Ethnic Minorities
Ethnic Minority needs (2) – Figure 12
<0.5% 0.5-1% 1-2% 2-4% 4%or >
Proportion in Black & Ethnic Minorities
-1.00
-0.50
0.00
0.50
1.00
1.50
HE
AR
T_r
es
S02000036
S02000604
S02000158 S02000195
S02001003
S02000630S02000910S02000521
S02000793S02000117S02001037
S02000799
S02000656
S02000446
S02000343S02000780
S02000223
S02001001S02000912
S02000482S02000063
S02000668
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 ?)
Ethnic Minority needs (3)
Rurality needs – Figure 13
Large urban Other urban Accessible small towns
Remote small towns
Accessible rural
Remote rural
SEURC 6 fold
-0.60
-0.40
-0.20
0.00
0.20
0.40
0.60
OU
T_A
CU
_re
s
S02000176
S02000116
S02000110
S02000970
S02000435S02000674
S02000279
S02000944
S02000583S02000925
S02000926
S02000973
S02000195
S02000137
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
Rurality needs (2)
1. Shortfall method
2. Variations method
3. Comparison with disease prevalence
Unmet Need - deprivation
Unmet Need - shortfall
High deprivation
utilisation
shortfall
Evidence of shortfall:
• Circulatory, Acute – other
• Dementia, Mental illness outpatients
Evidence of excess:
• Injuries
• Prescribing – CV, mental health, gastro, other
Unmet Need – Deprivation (Table 10)
Unmet Need - Variations
Needs index
utilisation Board A
Board B
Board C
Evidence of Board variations:
• Acute OP, Circulatory, Injuries, Respiratory Other
• Dementia, Mental illness outpatients
• Care of the elderly
• Maternity
• All Prescribing
Unmet Need – Deprivation (Table 11)
Scottish Health Survey 2003
• Sample size 11,000 +
• Postcodes
• Ethnicity
• Long standing illness question
• ICD coded
Unmet Need – Disease Prevalence
Unmet Need – Cancer (Figure 14)
0.00 5.00 10.00 15.00 20.00
dep
0.0025
0.005
0.0075
0.01
0.0125
0.015
0.0175
can
c
Unmet Need – Circulatory (Figure 14)
0.00 5.00 10.00 15.00 20.00
dep
0.04
0.06
0.08
0.10
0.12
0.14
0.16
circ
Option 1 vs Option 2 ?
Option 1 vs simpler alternative ?
Flat funding or not ?
Maternity ?
Ethnic minorities/rurality ?
Unmet need ?
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
Recommendations
