Journal of health services research & policy
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J Health Serv Res Policy · Apr 2011
Comparative StudyUse of secondary care in England by international immigrants.
Although over half a million migrants arrive in England each year, information about their use of health services is limited. Our aim was to describe the use of secondary care by international immigrants and compare it to people moving within England. ⋯ The assumption that international immigrants use more secondary care than the members of the indigenous population appears to be unfounded.
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J Health Serv Res Policy · Apr 2011
The impact of patient choice of provider on equity: analysis of a patient survey.
To understand the impact on equity of giving patients a choice of provider. ⋯ More educated, affluent patients were no more likely to be offered a choice than other population groups, but there does appear to be a social gradient in who chose to travel beyond the local area for treatment. If these results were replicated across England, there is at least the potential risk that when local hospitals are failing, patient choice could result in inequitable access to high quality care, rather than enhancing equity as the policy's architects had hoped.
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J Health Serv Res Policy · Apr 2011
General practitioner commissioning consortia and budgetary risk: evidence from the modelling of 'fair share' practice budgets for mental health.
To contribute to current policy debates regarding the devolution of commissioning responsibilities to locally-based consortia of general practices in England by assessing the potential magnitude and significance of budgetary risk for commissioning units of different sizes. ⋯ Unless steps are taken to mitigate budgetary risk, the devolution of decision-making and introduction of fixed budgets is likely to result in significant financial instability. It will be difficult to reconcile the policy objectives of devolved commissioning, best met through relatively small and fully accountable consortia, with the need for financial stability, which is best met by pooling risk across larger populations.
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Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and well-being in the English National Health Service (NHS) and the governance paradoxes which emerge. ⋯ As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing.