The inclusion of Ethnicity V, counting all populations with better than average health, was motivated by the observation that some of the populations that would be included (e.g. White Polish) are much larger than the populations with poorer than average health; a variable using these populations could therefore be a better differentiator of need than Ethnicity variables II, III or IV. However, it was subsequently decided that this variable should not be used, because its relationship with the cost ratios would be in the opposite direction to that of the other indicators: higher values would be associated with lower cost. The subgroup had concerns about the face validity of appearing to penalise areas with more healthy populations, and about the practicality of combining variables into an index that had opposite-signed regression coefficients when entered individually. There was also a concern that ethnic group demographics may change more rapidly than can be captured adequately by a 10-yearly census; for example, in relation to possible political change such as changes in policy on immigration and asylum, or exit from the EU. The relative healthcare need of the different ethnic groups may also change over time, due to (for example) education, programmes to reduce inequity, and generational cultural change. The subgroup recommends that ethnicity is re-examined in future reviews if better ways of capturing it can be identified. 6.1.12 Did Not Attend (DNA) rate A recent study [11] has shown that the outpatient Not (DNA) rate (as a ‘Did Attend’ percentage of total outpatient appointments) is highest among those living in more deprived and / or urban areas. It was also found that the patterning of DNA has been relatively stable for the past 10 years. The DNA variable was included in the final list of potential indicators, and proved to be a strong indicator of utilisation; however, the subgroup decided to exclude it due to concerns that as a variable it is not appropriate and may be seen to set up a perverse “supply-side” incentive. Improving DNA rates is also a key performance indicator for boards and so improvement in DNA rates is intended, and this may affect the stability of the formula. 6.1.13 Low birth weight births Data was available from ISD on numbers of births with low birth weight. This was included because of its well-documented relationship with deprivation [12].
The inclusion of Ethnicity V, counting all populations with better than average health, was motivated by the observation that some of the populations that would be included (e.g. White Polish) are much larger than the populations with poorer than average health; a variable using these populations could therefore be a better differentiator of need than Ethnicity variables II, III or IV. However, it was subsequently decided that this variable should not be used, because its relationship with the cost ratios would be in the opposite direction to that of the other indicators: higher values would be associated with lower cost. The subgroup had concerns about the face validity of appearing to penalise areas with more healthy populations, and about the practicality of combining variables into an index that had opposite-signed regression coefficients when entered individually. There was also a concern that ethnic group demographics may change more rapidly than can be captured adequately by a 10-yearly census; for example, in relation to possible political change such as changes in policy on immigration and asylum, or exit from the EU. The relative healthcare need of the different ethnic groups may also change over time, due to (for example) education, programmes to reduce inequity, and generational cultural change. The subgroup recommends that ethnicity is re-examined in future reviews if better ways of capturing it can be identified. 6.1.12 Did Not Attend (DNA) rate A recent study [11] has shown that the outpatient ‘Did Not Attend’ (DNA) rate (as a percentage of total outpatient appointments) is highest among those living in more deprived and / or urban areas. It was also found that the patterning of DNA has been relatively stable for the past 10 years. The DNA variable was included in the final list of potential indicators, and proved to be a strong indicator of utilisation; however, the subgroup decided to exclude it due to concerns that as a “supply-side” variable it is not appropriate and may be seen to set up a perverse incentive. Improving DNA rates is also a key performance indicator for boards and so improvement in DNA rates is intended, and this may affect the stability of the formula. 6.1.13 Low birth weight births Data was available from ISD on numbers of births with low birth weight. This was included because of its well-documented relationship with deprivation [12].
TAGRA-26th-meeting-25-August-2016-AMLC-final-report.docx