Title: Accounting for Unmet Need in Equitable Healthcare Resource Allocation
Funder: Department of Health and Social Care

Abstract: The NHS in England uses various formulae to share out its budget of £87 billion between local areas. These aim to provide more money per person to areas with greater need for healthcare compared to areas with fewer needs. Currently the NHS uses information on how different groups of people have used health care services in the past to work out how much need they have. For example people at older ages and those living in poorer areas tend to use more NHS services than younger people and those living in more affluent areas, so these groups are assessed as having greater needs. There are concerns that the current approach does not take into account that some groups of people are less likely to use healthcare services even when they need them. That might mean the current approach underestimates need in some places. This research aims to calculate the amount of “unmet need” in different areas across the UK so that the formulae can be adjusted for this. This will mean that NHS resources can be shared out more fairly between places, so that places with more unmet needs receive more money to improve access for groups of people who aren’t currently receiving the care they need. _x000D_ In this research we will measure unmet need in two ways. First we will identify how the current formula can be changed to account for the fact that some population groups (e.g certain ethnic groups) use fewer health services than we would expect. Secondly using high-quality survey data alongside linked health service and mortality data, we will estimate how many people there are in each part of the UK with unmet needs for health care. Specifically we will estimate the number of people who have a chronic health condition but have not yet been diagnosed or received treatment. We will estimate how much it would cost to treat these people and propose an adjustment to the formula that would provide sufficient additional resources to each area to allow local health services to do this. Finally we will work out how making this adjustment will affect overall levels of health and differences in health between places in England. _x000D_ The research will indicate improvements in the way NHS resources are shared out between places to better meet people’s needs and demonstrate the impact these changes are likely to have on health and health inequalities. It is expected that this will lead to more investment in areas with higher unmet needs leading to improved health outcomes in those populations.

Lay abstract: The NHS allocates a total of £87 billion to Clinical Commissioning Groups in England to fund healthcare using formulae that aim to estimate the level of need in each area. These formula largely use the historic patterns of utilisation as a proxy indicator of need. There is a concern, however, that these formulae do not sufficiently take into account the level of unmet need in a CCG. In other words people who could benefit from healthcare but do not currently receive it. Whilst premature mortality rates in each area are used to adjust funding to take account of this and address health inequalities, we do not know whether this adjustment accurately reflects variation in unmet need between areas. Better measurement of unmet need, would lead to more investment in areas with higher unmet needs leading to improved health outcomes in those populations._x000D_ _x000D_ _x000D_ Whilst there is evidence indicating that significant unmet needs for healthcare exists, a recent systematic review concluded that there is little useable evidence for measuring variation in unmet need between geographical areas that could inform resource allocation.1 We will address the gaps in this evidence base using the best data and methods available to estimate the level of unmet need in each CCG in England. Firstly we will develop our conceptual understanding of unmet need for healthcare as it relates to resource allocation through a review of the literature and through engagement with members of the public, policy makers and health service experts to develop a typology of different approaches. Secondly we will systematically test out modifications to the current formula to develop approaches that better take account of unmet need. Thirdly we will use multiple high-quality nationally representative data sources alongside local data on risk factors and diagnosed prevalence to construct a dynamic microsimulation model for key chronic conditions providing an adjustment for unmet need based on the additional healthcare costs required in each CCG to treat those previously undiagnosed. Recognising that an objective for resource allocation is also to contribute to the reduction in avoidable health inequalities we will use data on historical changes in funding to estimate the impact of increased funding on health outcomes. The will be used to estimate the effect of alternative adjustments for unmet need on health inequalities. _x000D_ _x000D_ _x000D_ The research will produce a set of alternative and complementary adjustments for unmet need that can be used in resource allocation formulae. Alongside this we will produce a rigorous assessment of the uncertainties and assumptions of each approach and the likely health inequalities impact of these adjustments. The open source microsimulation model produced through the research will be available for use by local CCGs providing them with information on the populations most affected by unmet need, and the costs and benefits of addressing this problem.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE