Publications
310 results found
Carr-Hill RA, Rice N, Smith PC, 1999, The determinants of expenditure on children's personal social services, BRITISH JOURNAL OF SOCIAL WORK, Vol: 29, Pages: 679-706, ISSN: 0045-3102
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- Citations: 13
Goddard M, Mannion R, Smith PC, 1999, Assessing the performance of NHS Hospital Trusts: the role of ‘hard’ and ‘soft’ information, Health Policy, Vol: 48, Pages: 119-134, ISSN: 0168-8510
Pedraja-Chaparro F, Salinas-Jiménez J, Smith P, 1999, On the quality of the data envelopment analysis model, Journal of the Operational Research Society, Vol: 50, Pages: 636-644, ISSN: 0160-5682
Smith PC, 1999, Setting budgets for general practice in the new NHS, BMJ, Vol: 318, Pages: 776-779, ISSN: 0959-8138
Buck D, Eastwood A, Smith PC, 1999, Can we measure the social importance of health care?, INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol: 15, Pages: 89-107, ISSN: 0266-4623
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- Citations: 2
Martin S, Smith PC, 1999, Rationing by waiting lists: an empirical investigation, Journal of Public Economics, Vol: 71, Pages: 141-164, ISSN: 0047-2727
Davies HTO, Nutley SM, Smith PC, 1999, Editorial: What Works? The Role of Evidence in Public Sector Policy and Practice, Public Money and Management, Vol: 19, Pages: 3-5, ISSN: 0954-0962
Rice N, Smith P, 1999, Approaches to capitation and risk adjustment in health care: an international survey
This report is a survey of current capitation methods in health care finance in developed countries. It was commissioned as part of the fundamental review by UK Ministers of the formula used to allocate health care finance to local areas in England, being carried out under the auspices of the Advisory Committee on Resource Allocation (ACRA). The study was commissioned in February 1999 and completed in May 1999. It was informed by a review of published literature and an extensive network of contacts in government departments and academic institutions.A capitation can be defined as the amount of health service funds to be assigned to a person for the service in question, for the time period in question, subject to any national budget constraints. In effect, a capitation system puts a “price” on the head of every citizen. Capitations are usually varied according to an individual’s personal and social characteristics, using a process known as risk adjustment. In most nations, the intention is that the risk-adjusted capitation should represent an unbiased estimate of the expected costs of the citizen to the health care plan over the chosen time period (typically one year). There is an element of capitation funding in the health care systems of almost all developed countries. Capitation is seen as an important mechanism for securing both equity and efficiency objectives.The review examined capitation schemes in 19 countries and concentrated on major strategic risk adjustment schemes implemented at the national or regional level. It identified two broad approaches to setting capitations, which we term matrix methods and index methods. The fundamental difficulties affecting both approaches are a lack of suitable data and the problem of disentangling needs effects from supply effects on health care utilization. Almost all schemes rely on analysis of empirical data, and various analytic methods have been used for setting capitations. Numerous need and cost f
Martin S, Rice N, Smith PC, 1998, Risk and the general practitioner budget holder, Social Science & Medicine, Vol: 47, Pages: 1547-1554, ISSN: 0277-9536
Ozcan YA, Smith P, 1998, Towards a science of the management of health care., Health Care Manag Sci, Vol: 1, Pages: 1-4, ISSN: 1386-9620
Goddard M, Mannion R, Smith P, 1998, The NHS performance framework: taking account of economic behaviour
The provision of quantitative information has been given a key role in securing good performance in the new NHS. A new National Performance Framework has been proposed encompassing a number of dimensions of performance. Whilst this approach to managing the NHS is welcomed, it is essential to understand the strengths and limitations intrinsic to the use of performance indicators for this purpose. In particular, complex behavioural consequences may arise in response to the collection and dissemination of performance data, some of which may be unintended, potentially dysfunctional and damaging for the NHS. Results from a recent study on the performance of NHS Trusts are used to illustrate the sort of unintended side-effects which occur within the current system and which may in principle be replicated in the new system in future. Whilst the possibility of such consequences does not invalidate the potential of the new Performance Framework to secure the desired changes in the NHS, it does suggest that careful attention needs to be paid to the assessment of unanticipated side-effects.
Carr-Hill R, Rice N, Smith P, 1998, Towards locally based resource allocation in the NHS
In a health care system where resources are scarce and the principle of equity is of central concern, mechanisms for the appropriate allocation of resources based on the notion of relating resource use to some concept of need are essential. Two key issues raised in the UK government’s White Paper The New NHS: modern, dependable are the ability first to define health care budgets at a local level and second to integrate budgets to encompass all relevant aspects of health care delivery. This paper considers the theoretical and practical implications of devolving NHS budgets to primary care groups. The paper advocates the development of a patient-based survey of all NHS health care utilization, which could serve as the basis for integrated global budgets for use at a local level.
Goddard M, Mannion R, Smith P, 1998, Performance indicators. All quiet on the front line., The Health service journal, Vol: 108, Pages: 24-26, ISSN: 0952-2271
Managers interviewed in hospital trusts, health authorities and regional offices believed performance indicators to be broadly helpful. But our study found evidence that the role of the current performance indicators is distinctly limited. The indicators are primarily used to highlight instances of exceptionally poor performance. Frontline staff, such as junior doctors, are often largely unaware of performance indicators. Performance indicators have led to misrepresentation and manipulation of data.
Nutley S, Smith PC, 1998, League tables for performance improvement in health care., J Health Serv Res Policy, Vol: 3, Pages: 50-57, ISSN: 1355-8196
OBJECTIVES: Increasingly health care performance data are being disseminated in the form of 'league tables' of health care providers, with the implication that such publication helps purchasers select the better providers, and spurs providers into improvements. This paper examines progress to date. METHODS: Three stages of the league table process are considered: measurement, analysis and action. RESULTS: A wide range of measurement schemes are now in place, although the emphasis has been on process variables and mortality as a measure of outcome. Several analytical techniques have been deployed to help users make sense of league tables, and to help determine the causes of variations in reported performance. The weakest aspect of current methods relates to the use to which such analysis is put. CONCLUSIONS: A haphazard approach to using league table data exists, with few reports on the impact of publication. A variety of directions for future research into the use of performance data are needed.
Goddard M, Smith P, 1998, Equity of access to health care
The election of the Labour government last year shifted the issue of inequality in health to the top of the policy agenda. In its White Paper on the “New NHS”, promises were made about reducing unacceptable variations in services and ensuring fair access. Publication of the Green Paper “Our Healthier Nation” also reinforced the government’s aim of narrowing the health gap. Several national initiatives also have this aim, including the £30 million investment in Health Action Zones which are to target health inequalities and the establishment of a public enquiry into health inequalities, chaired by Sir Donald Acheson.However, much of the action required to tackle inequality will have to be undertaken at a local level. Indeed, the White Paper gave Health Authorities, in conjunction with other organisations inside and outside the NHS, the key task of improving health and reducing inequalities through their Health Improvement Programmes. If this task is to me manageable, those in the NHS will need to disentangle the many and complex stands involved in understanding the issue of inequality in health.This report attempts to clarify what is known in relationship to one of those issues – equity of access to health care services – and to draw out the policy implications of the research on this topic. Following an overview of methodological issues, research evidence on the extent and cause of inequities of access to services in the following five areas is summarised and analysed: GP consultations, acute care, mental illness, prevention and health promotion and long-term care. The policy and research implications are drawn out and some suggestions for future directions are made.The report is aimed at both policy makers and academics interested in the state of existing research and in designing and implementing their own studies into equity of access.
Mannion R, Smith P, 1997, How Purchasing Decisions are Made in the Mixed Economy of Community Care, Financial Accountability and Management, Vol: 13, Pages: 243-260, ISSN: 0267-4424
Under the ‘Community Care’ programme, English local authorities have become responsible for assessing the needs of those affected by problems associated with ageing, mental illness, learning difficulties or physical disability. They also have the responsibility of designing a suitable package of care for the individual, and for purchasing that care from a range of statutory, voluntary and private providers. This paper focuses on how purchasing decisions in community care are made. Concepts such as trust and reputation are found to be very important, and the paper therefore argues that the new economic sociology offers a more appropriate theoretical framework for examining the new market than the conventional neoclassical critique.
Smith PC, Stepan A, Valdmanis V, et al., 1997, Principal-agent problems in health care systems: An international perspective, HEALTH POLICY, Vol: 41, Pages: 37-60, ISSN: 0168-8510
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- Citations: 30
PedrajaChaparro F, SalinasJimenez J, Smith P, 1997, On the role of weight restrictions in data envelopment analysis, JOURNAL OF PRODUCTIVITY ANALYSIS, Vol: 8, Pages: 215-230, ISSN: 0895-562X
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- Citations: 126
CarrHill RA, Hardman G, Martin S, et al., 1997, A new formula for distributing hospital funds in England, INTERFACES, Vol: 27, Pages: 53-70, ISSN: 0092-2102
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- Citations: 15
Carr-Hill R, Dixon P, Mannion R, et al., 1997, A model of the determinants of expenditure on children's personal social services
Every year the United Kingdom central government assesses the relative spending needs of English local authorities in respect of the services for which is it responsible. This is done by estimating a Standard Spending Assessment (SSA) for each service, which is intended to indicate the spending requirements of an authority if it were to adopt a standard level of services, given the circumstances in its area. In practice, statistical methods are used to develop SSAs for most services. This report describes the findings of a study designed to review the methods for setting SSAs for a single service: personal social services (PSS) for children, which in 1995/96 accounting for about £1.8 billion of expenditure (4.4% of total local government expenditure).The study was commissioned by the Department of Health and undertaken by a consortium which comprised The University of York, MORI and the National Children’s Bureau. The study was guided by a technical advisory group, comprising representatives from the local authority associations and the Department of Health. In seeking to limit the length of the report, the authors have necessarily omitted a great deal of the technical material produced in the course of the study. We understand that the Department of Health is willing to make this material and the data used in the study available to interested parties, subject to certain confidentiality restrictions.Existing methodology for constructing SSAs had been the subject of some criticism, both in general and specifically in respect of children’s PSS. This document reports the results of a study designed to apply a radically new statistical approach to estimating the SSA for children’s PSS. Previous methods were based on statistical analysis of local authority aggregate data. In contrast, this study is based on an analysis of PSS spending in 1,036 small areas (with populations of about 10,000) within 25 local authorities. A relatively new st
Smith P, 1997, Model misspecification in data envelopment analysis, ANNALS OF OPERATIONS RESEARCH, Vol: 73, Pages: 233-252, ISSN: 0254-5330
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- Citations: 129
Smith P, Sheldon TA, Martin S, 1996, An index of need for psychiatric services based on in-patient utilisation, BRITISH JOURNAL OF PSYCHIATRY, Vol: 169, Pages: 308-316, ISSN: 0007-1250
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- Citations: 59
Martin S, Smith P, 1996, Explaining variations in inpatient length of stay in the National Health Service, JOURNAL OF HEALTH ECONOMICS, Vol: 15, Pages: 279-304, ISSN: 0167-6296
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- Citations: 39
Orme C, Smith P, 1996, The potential for endogeneity bias in data envelopment analysis, Journal of the Operational Research Society, Vol: 47, Pages: 73-83, ISSN: 0160-5682
Data envelopment analysis has become an important technique for modelling the relationship between inputs and outputs in the production process, particularly in the public sector. However, whenever measures of the output of public sector activity receive public attention, there is a strong possibility that there will be a feedback from the achieved output to the resources devoted to the activity. In other words, the level of resources is endogenous. The implications of such endogeneity for standard econometric estimation techniques are well known, and methods exist to deal with the problem. Most commentators have assumed that endogeneity poses no analogous problems for DEA because the technique merely places an envelope around feasible production possibilities. Using Monte Carlo simulation techniques, however, this paper shows that the efficiency estimates generated by DEA in the presence of endogeneity can be subject to bias, in the sense that inefficient units using low levels of the endogenous resource may be set tougher efficiency targets than equally inefficient units using more of the resource, particularly when sample sizes are small. The paper concludes that, in such circumstances, great caution should be exercised when comparing efficiency measures for units using different levels of the endogenous input. © 1996, Operational Research Society Ltd. All rights reserved.
Orme C, Smith P, 1996, The potential for endogeneity bias in data envelopment analysis, JOURNAL OF THE OPERATIONAL RESEARCH SOCIETY, Vol: 47, Pages: 73-83, ISSN: 0160-5682
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- Citations: 27
SalinasJimenez J, Smith P, 1996, Data envelopment analysis applied to quality in primary health care, ANNALS OF OPERATIONS RESEARCH, Vol: 67, Pages: 141-161, ISSN: 0254-5330
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- Citations: 63
Martin S, Sheldon TA, Smith P, 1995, Interpreting the new illness question in the UK census for health research on small areas, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 49, Pages: 634-641, ISSN: 0143-005X
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- Citations: 13
Martin S, Smith P, 1995, Modelling waiting times for elective surgery
Throughout the first 25 years of the NHS there were, at any point in time, about half a million people waiting for hospital treatment in England. Over the next two decades this figure doubled, and waiting times have become a subject of great public concern. Partly in response to this concern, the Government has launched various initiatives to reduce the time that patients have to wait for treatment, most recently in the Patient’s Charter. However, despite considerable political, professional and public interest, our understanding of the determinants of waiting times remains poorly developed (Pope, 1992).In this study, in common with most commentators, we focus on waiting times for elective surgery. These are a complex phenomenon, being a function of numerous interlinked factors. It has rarely been possible to undertake empirical work within a coherent theoretical framework that permits simultaneous modelling of all the major determinants of waiting times. Usually, analysis of the phenomenon has been confined to unrealistically simple models, or of piecemeal examination of variables thought relevant to waiting times. It has hitherto proved impossible to examine the impact of one particular factor on waiting times while holding all other factors constant (see, for example, Yates, 1987).It might reasonably be assumed that the length of waiting time is related to the adequacy of resources for treatment (Sanderson, 1982). Indeed, in comparison with many other industrialised countries, the UK spends a relatively small proportion of its GDP on health (Yates, 1987, pp.30-31). However, claims that there is no straightforward relationship between resource provision and waiting times abound (for example, Frankel, 1989; Buttery and Snaith, 1979). Unfortunately, this view is usually based on simple correlations between some measure of inpatient provision and waiting times. For example, Buttery and Snaith concluded that “waiting lists are not correlated wit
SMITH P, 1995, LARGE-SCALE MODELS AND LARGE-SCALE THINKING - THE CASE OF THE HEALTH-SERVICES, OMEGA-INTERNATIONAL JOURNAL OF MANAGEMENT SCIENCE, Vol: 23, Pages: 145-157, ISSN: 0305-0483
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- Citations: 7
DUNCAN A, SMITH P, 1995, Modelling Local Government Budgetary Choices under Expenditure Limitation, Fiscal Studies, Vol: 16, Pages: 95-110, ISSN: 0143-5671
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- Citations: 11
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