THE NATURAL LIFE OF POLICY INDEXES - GEOGRAPHICAL PROBLEM AREAS IN THE US AND UK

In spite of many fundamental differences between the health systems in the U.S. and U.K., each has pursued a policy of identifying geographi cal small-areas believed to have inadequate primary care physicians gi ven local health care needs. The magnitude of the problems in such are as differ in the U.S. and U.K. leading to idiosyncratic policy respons es that ale dictated by overall health system realities. However, ther e are several common themes identified in this comparative study: goal s for remedial health policy are often unclear, making evaluation diff icult; in the absence of conceptual clarity, a consensus-based approac h of identifying existing and widely available variables to designate areas has been used to identify geographical problem areas; there are widespread concerns that the present indices used to implement policy are inappropriate, but Ilo alternative index has been adopted. The pap er concludes that clarifying goals for remedial health policy is key i f the effectiveness of such policy is to be improved. Guidelines for a ssessing the usefulness of existing and future indices used to designa te areas as eligible for resources as a part of this type of small-are a remedial policy are developed from this U.S./U.K. comparison. (C) 19 98 Elsevier Science Ltd..All rights reserved.