THE DETERMINANTS OF HOSPITAL UTILIZATION - IMPLICATIONS FOR RESOURCE-ALLOCATION IN ENGLAND

Since 1976 various attempts have been made to ensure that NHS resource s available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The curren t method is based on analyses of the links between observed patterns o f in-patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this a pproach, however, and so the search continues for new analytical techn iques. The purpose of this paper is to explore how household survey da ta about 12,729 English adults could be used to inform resource alloca tion decisions. Health care need indicators can be developed based on Census information and odds ratios derived from logistic regression an alyses of the relationships between hospital utilization, health statu s, socio-demographic characteristics and area indicators of supply. Th e results suggest that health status is the most important determinant of hospital utilization, although demographic and socio-economic fact ors also have some influence. In addition to the personal characterist ics of individual respondents, area correlates of health care supply a re also positively associated with reported utilization. The final par t of the paper illustrates how weighted population estimates might be calculated on the basis of empirically-derived indicators of health ca re need.