Over the last 50 years there has been a regular cycle of Government committees which have forecast “shortages” and “surpluses” in medical manpower. It is remarkable how little change there has been in the methods used in these forecasts. This has occurred despite regular critiques of the...

Implementing the findings of research to change the behaviour of health care professionals has become an increasingly prominent issue. However, designing valid studies to evaluate different methods of achieving changes requires considerable care and there are a number of pitfalls evident from...

This paper summarises the cost-effectiveness work which has been carried out on alternative patterns of care for elderly people, people with a mental handicap and people with chronic mental illness. The amount of work completed varies according to the client group concerned. There is, for...

A composite indicator is an aggregated index comprising individual performance indicators. Composite indicators integrate a large amount of information in a format that is easily understood and are therefore a valuable tool for conveying a summary assessment of performance in priority areas....

It is frequently claimed that social justice requires that some goods – medical care is a frequently cited example – be distributed according to “need”. The most common justification for adoption of this principle is the cause of inequality: the principles of “distribution according to...

Housing is a key element in maintaining well-being and independence in old age. However, the elderly live in worse housing conditions than younger people in terms of unsuitable housing, accommodation which is draughty, cold and lacking in basic amenities and in properties in a poor state of...

General Medical Services (GMS) are provided mainly through Family Practices, on a demand led basis: that is, there is no cash limit expect for certain specified selected services such as Practice Nurses etc. Nevertheless, since 1948, the Medical Practices Committee (MPC) have influenced the...

The NHS Executive has recently implemented modifications to the weighted capitation formula for distributing Hospital and Community Health Service funds to health authorities in England. A major contribution to the changes was an analysis of the relative needs of geographical areas undertaken by...

The recent reorganisation of community care removed many of the perverse incentives identified in the previous system. However, the organisation of care for many people is still divided across several agencies in the public and independent sectors. As purchasing and providing agencies in both...

An inappropriate structure for a decision analytic model can potentially invalidate estimates of cost-effectiveness and estimates of the value of further research. However, there are often a number of alternative and credible structural assumptions which can be made. Although it is common...