Theoretical and practical equity in the national health service in England

Abstract

This paper is concerned with the evaluation of recent policy attempts to achieve a more equitable allocation of resources to the regions of England for the provision of health services. Alternative objective functions, derived from the policy statements of governments for the health service, are examined. These objective functions represent the view of the policy-maker and are based on the aggregation of health service effects on individuals. The appropriate treatment of equity-efficiency conflicts is examined in order to identify the policy response to variations in the cost of providing treatment in different geographical areas. The implications are then used to generate the optimal allocation to each region based on the individuals in the regional populations.

The theoretical framework developed is used to judge the appropriateness of recent British policy to achieve equity in the National Health Service. This section focuses on the 1976 policy proposals which attempt to introduce epidemiological and demographic data as the sole bases for regional provision, replacing earlier schemes which contained large, historical influences on funding.