Variations in general practice prescribing costs and implications for budget setting.

Indicative prescribing amounts, and the equivalent prescribing element of funds in the case of fund-holding practices, are now an established part of UK general practice. This paper examines the implications of variations in GP prescribing behaviour for the determination of prescribing budgets. Using regression analysis, the extent to which variations in total practice prescribing costs can be explained by factors suggested for inclusion in a weighted capitation formula is established. The results indicate that 97% of the variation in practice prescribing costs can be explained by differences in practice list size, the proportion of patients aged 65 years and over, the proportion of patients living in 'deprived areas' and whether or not the practice qualifies for 'inducement payments'. The implications of the results for budget setting are discussed. A resource allocation formula based on regression analysis of expenditures can be used to promote horizontal equity in terms of equal budgets for equal need. However, its implications for vertical equity and efficiency are more ambiguous.

What do international comparisons of health care expenditures really show?

There is much interest in international comparisons of health care expenditures, in particular their relation to national income. They have been widely used to judge countries' performance in cost-containment, and in the United Kingdom have been widely quoted in debates about the funding of the National Health Service. This paper challenges conclusions drawn from simple analyses of this topic, which have used dubious and inappropriate data, questionable methods and assumptions, and simplistic ad-hoc reasoning. It looks particularly at price differences between countries, which have usually been hidden by using exchange rates to standardize national figures. When more appropriate conversion factors called purchasing power parities are used, many of the simple and conventionally-accepted conclusions no longer appear so obvious. The attempt to create apparent scientific facts for policy debates has been based on a misuse of international comparisons.

Costing of a hospital-based outbreak of poultry-borne salmonellosis.

Poultry-borne salmonellosis is the most common form of foodborne infection in Scotland for which the vehicle can be identified, yet little is known about the costs imposed on society by this disease, or the costs of preventing it. The present study identifies and values the costs of a hospital based outbreak of poultry-borne salmonellosis. Account is taken of costs falling on individuals, the health services and society as a whole. Depending on assumptions made about the value of 'intangibles', the cost of the outbreak is estimated to be between pounds 200,000 and pounds 900,000.

Prevention of poultry-borne salmonellosis by irradiation: costs and benefits in Scotland.

Poultry-borne salmonellosis is the most common foodborne infection in Scotland for which the vehicle can be identified. The cost of the disease to society in terms of health service use, absence from work, morbidity, and mortality is substantial. The study estimates the total cost of poultry-borne salmonellosis in Scotland and compares it with the cost of a single preventive measure: the irradiation of poultry meat. The results suggest that the public health benefits exceed irradiation costs. This conclusion is, however, sensitive to assumptions made in the analysis, particularly those related to the cost of unreported cases of salmonellosis.

The economics and evaluation of dental care and treatment.

This paper is concerned with economic evaluation in dentistry. The potential for such evaluation is great, but has not been fully realised to date. A number of issues which are common to the existing literature are discussed, and particular attention is paid to the question of measuring dental health in economic appraisal. Directions for future research are presented. The paper concludes that the future for economic evaluation in dentistry is favourable and that there is a need for greater collaboration between economic and dental researchers in this area.

Need and decision making in dentistry--an economic perspective.

The issue of alternative definitions of need has recently received attention in the dental literature. However, a number of important questions have gone unanswered. Why is it necessary to assess needs; who is to do the assessing and in what decision making contexts are needs to be assessed? This paper presents an economic rationale for assessing needs. Scarcity necessitates choices as to how resources will be used, and it is only by identifying needs and the costs of meeting them that such choices can be made rationally and explicitly. Three levels of decision making are distinguished, together with three assessors of need: patients, dentists and society. It is argued that decisions to seek care and to comply with professional instructions will ultimately rest with patients, whereas decisions as to which individual patients should be given treatment of what type will inevitably lie with the dental profession. In the latter case it is particularly important that dentists' judgements should reflect the social context of their decision making. At a wider community level, it is suggested that dental care professionals have a major role to play in assessing the potential for improvements in the oral health of the population, while the task of making societal decisions as to which needs ought to be met is essentially that of policy makers. Once the legitimate roles of various parties in assessing needs in different decision settings have been established, the concept of need has a key contribution to make to the planning and provision of dental care services.