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A new set of weighted capitation formulas are being used for allocating resources to health service "purchasers." Since the 1970s the NHS has used formulas to promote a more equitable allocation of resources for hospital and community care. The Resource Allocation Working Party (RAWP) recommended that cash should be distributed on the basis of the size and age-sex distribution of an area's population, taking into account relative health care needs as indicated by its standardised mortality ratio. 1 This highlighted the fact that the regions in the south of England were receiving more than their fair share of resources and initiated a gradual redistribution to the poorer and sicker north.
In the 1980s regression analysis was used to estimate the influence of health and socioeconomic factors on health care use. 2 Recent research at York University used more statistically appropriate techniques which also adjust better for the effect of variations in supply and consider resource use rather than just bed days. The resulting indices of need for acute 3 and psychiatric 4 health services are more sensitive to the influence of socioeconomic factors and, had they been implemented, would have redistributed resources from richer to poorer districts. However, the previous government decided to allocate only around 75% of the funds using these needs weights. Most of the community health services budget was excluded on the pretext that the research was based on hospital episodes: community health service data are not routinely recorded. The decision not to weight the community health services budget according to need contradicted the epidemiological evidence. 5 The effect was...