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First steps in analysing NHS waiting times: avoiding the 'stationary and closed population' fallacy

STATISTICS IN MEDICINE 2000年第15期19卷 2037-2051页

作者： Armstrong, PW Univ E London Dept Hlth Sci London E15 4LZ England

The aim of this paper is to demonstrate the effect of excluding incomplete observations and competing events when calculating cross-sectional measures of NHS waiting times, and to obtain a more accurate estimate of the 'time-to-admission' of those listed on NHS waiting lists using lifetable methods. The official 'times-since-enrolment' of all elective 'admissions' in England, 1 July to 31 December 1994 inclusive, were extracted from Hospital Episode Statistics. The official 'times-to-census' of all those on a waiting list in England at 30 September 1994 were obtained from aggregated KH07 data. The percentage waiting at least three months, at least six months etc., was calculated separately for each data set and compared with a period lifetable derived from the combined data. The cumulative likelihood of elective admission is markedly overestimated across the whole range of waiting times. The experience of those still waiting, those removed from the list, those suspended or deferred and those put to the back of the queue is not taken into account in the calculation of official waiting times. The Department of Health currently presents the 'time-since-enrolment' of those admitted as though it indicates how long all patients can expect to wait for admission. The consequent bias in published summary statistics incorrectly quantifies the real experience of patients. It is recommended that calculation of waiting times from KH07 census counts and Hospital Episode Statistics be reconsidered in the light of what patients, clinicians, managers and politicians need to know about treatment delay. Copyright (C) 2000 John Wiley & Sons, Ltd.

关键词：急症英格兰政府机构住院/统计学和数值数据寿命表似然函数概率公费医疗/统计学和数值数据时间因素预约名单

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Visibility and the just allocation of health care: A study of Age-Rationing in the British national Health Service

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Health Care Analysis 1993年第2期1卷 139-150页

作者： Baker, Robert Philosophy Department Humanities Center Union College Schenectady 12308-2371 New York United States

The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to 'universalise the best'. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the 'done thing' without explicit policy directives and in a manner largely invisible to patients, to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity;they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment;and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. © 1993 John Wiley & Sons, Ltd.

关键词：年龄因素数据收集伦理理论欧洲/流行病学大不列颠/流行病学卫生保健公平提供/标准卫生保健公平提供/统计学和数值数据信息传播国际性肾功能衰竭慢性/流行病学肾功能衰竭慢性/治疗病人遴选转诊和会诊/标准肾透析/统计学和数值数据肾透析/利用资源分配性别因素社会正义公费医疗/标准公费医疗/统计学和数值数据阻断疗法老年人女(雌)性人类男(雄)性中年人

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EQUITY IN THE DELIVERY OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 389-411页

作者： VANDOORSLAER, E WAGSTAFF, A UNIV SUSSEX SCH SOCIAL SCIARTS BLDGBRIGHTON BN1 9QNENGLAND ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but that there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/标准卫生保健提供/统计学和数值数据欧洲卫生经费支出/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务研究收入/分类保险健康/经济学保险健康/标准保险健康/统计学和数值数据国际性模型经济计量学国家卫生规划/经济学国家卫生规划/标准国家卫生规划/统计学和数值数据回归分析社会正义/经济学社会经济因素公费医疗/经济学公费医疗/标准公费医疗/统计学和数值数据美国

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THE EFFECT OF PER-ITEM FEES ON THE BEHAVIOR OF GENERAL-PRACTITIONERS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 413-437页

作者： HUGHES, D YULE, B UNIV ABERDEEN DEPT PUBL HLTHHLTH ECON RES UNITABERDEEN AB9 1FXSCOTLAND

The recent government White Paper 'Working for Patients' emphasised the use of financial incentives as a means of altering the behaviour of general practitioners (GPs) in the U.K. This paper examines the impact of financial incentives on GPs' behaviour with respect to maternity care and cervical cytology. Changes in per-item fees over the period 1966-89 appear to have had little effect on the numbers of treatments;rather service provision was related to patient demand and the availability of GPs. However, target payments for cervical cytology introduced in 1990 appear to have had a major impact.

关键词：费用医疗/统计学和数值数据卫生服务需求/经济学卫生服务需求/统计学和数值数据卫生服务研究产妇卫生保健服务/经济学产妇卫生保健服务/统计学和数值数据模型经济计量学多元分析医师家庭/经济学医师家庭/统计学和数值数据回归分析偿还奖励公费医疗/经济学公费医疗/统计学和数值数据宫颈肿瘤/诊断宫颈肿瘤/经济学女(雌)性人类妊娠

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EQUITY IN THE FINANCE OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 361-387页

作者： WAGSTAFF, A VANDOORSLAER, E ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/统计学和数值数据欧洲筹资政府/经济学筹资政府/方法筹资政府/统计学和数值数据卫生经费支出/统计学和数值数据卫生服务研究保险健康/经济学国际性模型经济计量学国家卫生规划/经济学国家卫生规划/组织和管理国家卫生规划/统计学和数值数据回归分析公费医疗/经济学公费医疗/组织和管理公费医疗/统计学和数值数据税款/经济学美国

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Formula funding in a multidisciplinary medical library: a case study at St George's Hospital Medical School, University of London.

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Health libraries review 1992年第2期9卷 81-82页

作者： Gove, S. St George's Hospital Medical School London United Kingdom

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A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England

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BRITISH DENTAL JOURNAL 2000年第10期188卷 554-558页

作者： Palmer, NAO Pealing, R Ireland, RS Martin, MV Univ Liverpool Dept Clin Dent Sci Liverpool L69 3BX Merseyside England

Objective To study the therapeutic prescribing of antibiotics by general dental practitioners. Design A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. Subjects General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaire were received from 929 (60.1 %) practitioners. More than 95 % of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5 %) prescribed antibiotics for acute pulpitis and (3.3 %) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69 %) and by 23 % after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92 %), but would prescribe when under pressure of time (30.3 %), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5 %). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. Conclusions The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in Nation

关键词：脓肿/外科学急性病阿莫西林/治疗应用抗菌药/治疗应用抗感染药/治疗应用细菌感染/药物疗法慢性病牙医病人关系引流术药物处方/统计学和数值数据药物利用/统计学和数值数据干槽症/药物疗法英格兰/流行病学开业医生牙科/统计学和数值数据牙龈炎/药物疗法牙龈炎坏死溃疡性/药物疗法甲硝唑/治疗应用青霉素类/治疗应用冠周炎/药物疗法牙髓炎/药物疗法公费医疗/统计学和数值数据女(雌)性人类男(雄)性

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Measuring disability and mortality following relocation within the NHS

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AGE AND AGEING 2002年第5期31卷 414-414页

作者： Crome, P Jones, P Keele Univ Postgrad Med Sch N Staffordshire Hosp Dept Geriatr Med Stoke On Trent ST4 7QB Staffs England Keele Univ Postgrad Med Sch N Staffordshire Hosp Dept Math Stoke On Trent ST4 7QB Staffs England

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