A paper examined resource allocation formulae used in the National Health Service in England.
Source: Mervyn Stone, Explicating Wrong or Questionable Signs in England's NHS Funding Formulas: Correcting wrong explanations, Civitas
Links: Paper
Date: 2013-Dec
An article examined the adoption and success of payment schemes that promoted integration of chronic care in selected European countries. All payment reforms appeared to have changed the structure of chronic care delivery. 'Pay for co-ordination' – in Austria, France, and Germany – was perceived to be the most successful in increasing collaboration within and across healthcare sectors. 'Pay for performance' – in England and France – was perceived to be most successful in improving other indicators of the quality of the care process. The impact of the payment reforms on healthcare expenditures remained questionable. The success of a payment scheme depended on the details of the specific implementation in a particular country: but a combination of the schemes might overcome the barriers of each individual scheme.
Source: Apostolos Tsiachristas, Carolien Dikkers, Melinde Boland, and Maureen Rutten-van Molken, 'Exploring payment schemes used to promote integrated chronic care in Europe', Health Policy, Volume 113 Issue 3
Links: Abstract
Date: 2013-Dec
A government department published its response to the consultation on migrant access to, and charges for, National Health Service treatment in England. It said that some charges would be extended, and new charges introduced for accident and emergency services. There would be no exemption for charges for ante natal and maternity services, and a new system would be established for identifying and recording patients who were required to pay. The details for implementing the changes would be published in March 2014.
Source: Sustaining Services, Ensuring Fairness: Government response to the consultation on migrant access and financial contribution to NHS provision in England, Department of Health
Links: Response | Consultation document | DH press release | BBC report | Guardian report
Date: 2013-Dec
A report examined the financial implications of introducing seven day services for acute and emergency care, and supporting diagnostics, in the National Health Service.
Source: NHS Services, Seven Days a Week Forum, Costing Seven Day Services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics, Healthcare Financial Management Association
Links: Report | NHS England press release
Date: 2013-Dec
An article examined the consequences of population ageing for health expenditure growth in western countries. Ageing was most likely to influence growth in spending indirectly, through its influence on societal factors. It moderately increased spending on acute care, and strongly increased spending on long-term care. It reinforced the influence of medical technology on health expenditure growth, and vice versa.
Source: Claudine de Meijer, Bram Wouterse, Johan Polder, and Marc Koopmanschap, 'The effect of population aging on health expenditure growth: a critical review', European Journal of Ageing, Volume 10 Number 4
Links: Abstract
Date: 2013-Dec
A report examined NHS continuing care funding for people with Parkinson's disease in England. NHS continuing care was a funding package to provide free healthcare for people with severe health needs. The report said that 59 per cent of assessments did not involve a professional with specialist expertise or knowledge in the applicant's condition, and it noted inaccurate and incorrect decisions, as well as delays in receipt of funding. The report called for the government to redevelop the system.
Source: Failing to Care: NHS continuing care in England, All Party Parliamentary Group on Parkinson's
Links: Report | Summary | Parkinson's UK press release
Date: 2013-Nov
A report examined the degree of financial resilience in National Health Service trusts in England. It said that many trusts had adequate governance and monitoring in place, but highlighted areas of concern, particularly over the degree of some trusts' reliance on non-recurrent support funding.
Source: Alternative Therapy: Strengthening NHS financial resilience – summary findings from our financial health checks of English NHS trusts and foundation trusts, Grant Thornton
Links: Report | Grant Thornton press release
Date: 2013-Nov
A think-tank report examined the funding of health and social care and the role of user charging in healthcare. It said that the National Health Service faced an estimated funding gap of £30 billion by 2020. It suggested a range of possible charges to help meet the gap, including reforms to prescription charges, with options such as: an increased prescription charge of £10; the reduction or removal of charging exemptions for elderly people; and a system whereby only 20 per cent of drugs were dispensed free of charge, but alongside a reduced prescription charge. Other suggested charges included: a £10 flat rate charge for family doctor consultations; a £10 daily 'hotel' charge for overnight hospital stays; and a £10 fine for missed outpatient hospital appointments.
Source: Thomas Cawston and Cathy Corrie, The Cost of Our Health: The role of charging in healthcare, Reform
Links: Report | Reform press release | RPS press release | BBC report
Date: 2013-Nov
A report examined early findings from the Eurofund research project on the impact of the recent financial and economic crisis on access to publicly funded healthcare services in the European Union. It discussed the impact on the supply of, and demand for, services, and the ways in which access was affected. A final report from the project was intended for publication in 2014.
Source: Impacts of the Crisis on Access to Healthcare Services in the EU, European Foundation for the Improvement of Living and Working Conditions
Links: Report
Date: 2013-Nov
A report by a committee of MSPs said that National Health Service boards had engaged well with their enquiries, and with the work that had arisen from the previous year's report. It said that boards needed to strike a balance between savings and efficiencies, meeting local needs, and achieving quality and consistency of services across Scotland. It outlined further work to be completed on measuring the quality of outcomes, and maintenance backlogs. The committee anticipated using its new budget adviser to inform the ongoing approach.
Source: NHS Boards Budget Scrutiny, 10th Report 2013, SP Paper 419, Scottish Parliament Health and Sport Committee
Links: Report | Scottish Parliament press release
Date: 2013-Nov
An article examined the exercise of rationality in the work of Individual Funding Request panels in the National Health Service in England. It said there was a delicate balance between being human and being rational that created a dilemma for panels. It suggested placing greater value on narrative ethics as an aid to understanding resource allocation.
Source: Jill Russell and Trisha Greenhalgh, 'Being rational and being human : how National Health Service rationing decisions are constructed as rational by resource allocation panels', Health, Online first
Links: Abstract
Date: 2013-Nov
An article examined the findings from a study of disinvestment in the National Health Service. It reported that organizations had taken varied approaches, determined by both health system features and organizational characteristics. Interviewees reported that the easier disinvestment options had already been implemented, with more complex work now to be undertaken.
Source: Tom Daniels, Iestyn Williams, Suzanne Robinson, and Katie Spence, 'Tackling disinvestment in health care services: the views of resource allocators in the English NHS', Journal of Health Organization and Management, Volume 27 Number 6
Links: Abstract
Date: 2013-Oct
A report examined why some health economies managed better than others in times of financial constraint. Drawing on the experiences of health organizations in 'turnaround', the report concluded that there was a balancing act between short-term policy and strategic planning; between collaborative working and challenge; and between internally focused work and economy-wide considerations. The report noted the importance of support from policymakers and NHS England in enabling organizations to implement change.
Source: Natasha Curry, Benedict Rumbold, Richard Edwards, and Sandeepa Arora, Managing Financial Difficulties in Health Economies: Lessons for clinical commissioning groups, Nuffield Trust
Date: 2013-Oct
The coalition government announced that National Health Service hospitals in England would get an extra £500 million over two years to help struggling accident and emergency services, following warnings that some were on the brink of collapse.
Source: Press release 8 August 2013, Department of Health
Links: DH press release | BMA press release | FTN press release | MHP blog post | NHS Confederation press release | NHS England press release | RCGP press release | RCN press release | Unison press release | BBC report | Guardian report | Public Finance report
Date: 2013-Aug
A report said that the internal payments system in the National Health Service should be linked to outcomes instead of activity. A new method should be developed, based around full coverage of the range of payments between commissioners and secondary and tertiary healthcare providers, encouraging whole system working.
Source: Future Payment Systems in the NHS: An examination of the key characteristics for a reformed payment system, Healthcare Financial Management Association
Links: Report | Public Finance report
Date: 2013-Aug
An article examined attempts by governments in four European countries (the United Kingdom, Sweden, Germany, and the Netherlands) to cut healthcare costs. These attempts had both a financial and a moral dimension, for example when dealing with lifestyle-related health risks such as binge drinking or smoking. Promoting healthy lifestyles was increasingly being stimulated or even financially rewarded.
Source: Menno Fenger and Weys Qaran, 'New welfare in health insurances? Trends in risk-coverage and self-responsibility in four European countries', Social Policy and Society, Volume 12 Issue 4
Links: Abstract
Date: 2013-Aug
An audit report expressed concern about the financial resilience of 1 in 4 National Health Service trusts in England.
Source: Auditing the Accounts 2012/13: NHS Bodies, Audit Commission
Links: Report | Audit Commission press release
Date: 2013-Jul
The government responded to a report by a committee of MPs on public expenditure on health and care services. It said that it agreed with most of the Committee's overall conclusions, in particular about the scale of the financial challenge facing the health and care system. But it said that the system was well placed to achieve the efficiencies, and deliver the transformation, required to sustain and improve services in the future – thanks to the reforms that it had introduced, its commitment to increase health funding in real terms, and the steps being taken to promote integration of services.
Source: Government Response to the House of Commons Health Select Committee Report into Public Expenditure on Health and Care Services (Eleventh Report of Session 2012-13), Cm 8624, Department of Health, TSO
Notes: MPs report (March 2013)
Date: 2013-Jun
A study examined the changing balance between public and private spending on healthcare services. Between 1997 and 2011, public spending on health had grown more quickly than between 1975 and 1997, whereas growth in private health spending had slowed significantly. The impact of the economic crisis had also been greater on private spending. But the role of external providers in delivering National Health Service-funded care in England had increased markedly: in 2006-07 the NHS had spent £5.6 billion on care provided by external providers, whereas by 2011-12 this had increased to £8.7 billion.
Source: Sandeepa Arora, Anita Charlesworth, Elaine Kelly, and George Stoye, Public Payment and Private Provision: The changing landscape of health care in the 2000s, Nuffield Trust
Links: Report | IFS press release | Guardian report
Date: 2013-May
A think-tank report called for cuts in spending on the NHS and pensions on the grounds that they were 'unsustainable'.
Source: Cathy Corrie and Patrick Nolan, Seismic Shifts in the Welfare State: Demographic trends and pension and NHS reform, Reform
Links: Report | Telegraph report
Date: 2013-May
An article examined the cost-efficiency of private finance initiative (PFI) schemes in the delivery of hospital facilities. It highlighted 'significant problems' in procurement practices and the methodologies by which bids were assessed.
Source: Veronica Vecchi, Mark Hellowell, and Stefano Gatti, 'Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK', Health Policy, Volume 110 Issue 2
Links: Abstract
Date: 2013-Apr
A think-tank report said that coalition government reforms had produced 'strikingly more fragmented' resource allocation processes in the National Health Service in England than the previous ones. They risked creating a more complex decision-making process, and undermining other government policies that emphasized the importance of providing integrated care.
Source: David Buck and Anna Dixon, Improving the Allocation of Health Resources in England: How to decide who gets what, King s Fund
Links: Report | Kings Fund press release | Public Finance report
Date: 2013-Apr
The Welsh Government responded to a report by an Assembly Committee on health finances, saying that it accepted all the recommendations made.
Source: Response to the Report of the National Assembly for Wales Public Accounts Committee Report on Health Finances, Welsh Government
Links: Response
Notes: AM report (July 2012)
Date: 2013-Apr
A think tank published the results of two deliberative events with members of the general public that considered the level of future spending on health and social care. Participants strongly supported the founding principles of the National Health Service – access to healthcare based on need rather than the ability to pay, available to all, and of high quality – and wished these to endure. If user charges were to be introduced, there was support for applying them to 'not clinically necessary' procedures and for needs resulting from inappropriate lifestyle choices or misuse of the system.
Source: Amy Galea, Anna Dixon, Anastasia Knox, and Dan Wellings, How Should We Pay for Health Care in Future? Results of deliberative events with the public, King s Fund
Links: Report | Kings Fund press release
Date: 2013-Apr
A report by a committee of MPs said that the care provided by the health and social care system would break down without quicker progress in developing more integrated services. Responsibility for this process in a given area should be vested in the Health and Wellbeing Board. Joined-up commissioning would ensure that resources were no longer treated as 'belonging' to a particular part of the system, and instead became shared resources that were used more efficiently to deliver more flexible and responsive services. But this approach should not result in less overall funding: the coalition government's commitment to protect real-terms funding for healthcare should be extended to cover local authority social care services, and these funds should be ring-fenced at existing levels in real terms.
Source: Public Expenditure on Health and Care Services, Eleventh Report (Session 2012–13), HC 651, House of Commons Health Select Committee, TSO
Links: Report | Committee press release | Kings Fund press release | Labour Party press release | NHS Confederation press release
Date: 2013-Mar
A think-tank report examined patterns of spending and labour productivity in the National Health Service in England since 2003-04. The proportion of trusts in deficit had risen steadily: in the most recent year 32 trusts out of 250 had been in deficit, and 9 had reported a deficit for 3 years or more. The financing costs of private finance initiative (PFI) contracts had risen sharply since 2009: 7 acute trusts were paying out more than 5 per cent of their total revenue through PFI. There appeared to have been very little improvement in labour productivity across the hospital sector in recent years.
Source: Nick Jones and Anita Charlesworth, The Anatomy of Health Spending 2011-12: A review of NHS expenditure and labour productivity, Nuffield Trust
Links: Report | Nuffield Trust press release | BMA press release | Intergenerational Foundation press release | Guardian report
Date: 2013-Mar
A report by a committee of MPs said that the National Health Service had achieved its financial savings target, but this had in large part come from freezing wages. It expressed concern that other savings were being achieved by rationing patients' access to certain treatments – described as being 'of low clinical value', but waiting for which meant pain and a poorer quality of life. The finances of some NHS trusts were fragile, and there was a risk that they might resort to simple cost-cutting rather than finding genuine efficiency savings.
Source: Department of Health: Progress in Making NHS Efficiency Savings, Thirty-ninth Report (Session 2012–13), HC 865, House of Commons Public Accounts Select Committee, TSO
Links: Report | Committee press release | Kings Fund press release | Labour Party press release | RCN press release | Public Finance report
Date: 2013-Mar
A report examined the 'unprecedented' financial pressures facing the National Health Service, and the policy options available. It said that it was essential to rebuild public confidence in the service, and to involve patients, carers, and the public in the 'tough choices' that would need to be made.
Source: Tough Times, Tough Choices: Being open and honest about NHS finance, NHS Confederation
Links: Report | NHS Confederation press release | Labour Party press release
Date: 2013-Mar
A report by a committee of the National Assembly for Wales said that 'significant efforts' were being made to improve financial management within the National Health Service in Wales; and that substantial savings were being made. But financial forecasting by some local health boards appeared to be unrealistic and over-ambitious, while others had produced savings targets without identifying a realistic strategy to achieve them.
Source: Health Finances, Public Accounts Committee, National Assembly for Wales
Links: Report | Welsh Assembly press release
Date: 2013-Feb
A think-tank report said that health and social care could account for half of all government spending in 50 years' time. Changes to the population, increases in wealth, and medical advances would increase pressures to spend more on health and social care in the future. The ageing population would also be a factor, although – contrary to popular perception – this was likely to drive only a small proportion of the increase.
Source: John Appleby, Spending on Health and Social Care over the Next 50 Years: Why think long term?, King s Fund
Links: Report | Kings Fund press release | NHS Confederation press release | RCN press release | Daily Mail report | Guardian report | Public Finance report
Date: 2013-Jan
An article examined whether, by what means, and to what extent historically, government healthcare expenditure growth in Europe had changed following economic crises. In the year after an economic downturn, public healthcare expenditure was found to grow more slowly than would have been expected given the longer-term economic climate. Cost-shifting and other policy responses were both associated with these slowdowns. However, although changes in tax-derived expenditure were associated with both cost-shifting and other policy responses following a crisis, changes in expenditure derived from social insurance were associated only with changes in cost-shifting. Disproportionate cuts to the health sector, as well as reliance on cost-shifting to slow growth in healthcare expenditure, highlighted the potentially negative effects on equity, efficiency, and quality of health services – and, potentially, health outcomes – following economic crises.
Source: Jonathan Cylus, Philipa Mladovsky, and Martin McKee, 'Is there a statistical relationship between economic crises and changes in government health expenditure growth? An analysis of twenty-four European countries', Health Services Research, Volume 47 Issue 6
Links: Abstract
Date: 2013-Jan
An article said that European healthcare systems had not been particularly hit by retrenchment; and that convergence was absent in key healthcare dimensions, namely coverage and provision. Convergence appeared mainly in terms of the increased reliance on private healthcare financing.
Source: Ingalill Montanari and Kenneth Nelson, 'Social service decline and convergence: how does healthcare fare?', Journal of European Social Policy, Volume 23 Number 1
Links: Abstract
Date: 2013-Jan
