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Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis

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posted on 2023-06-09, 12:18 authored by Evangelos Kontopantelis, Mamas A Mamas, Harm van MarwijkHarm van Marwijk, Andrew M Ryan, Peter Bower, Bruce Guthrie, Tim Doran
Background Primary care provides the foundation for most modern health-care systems, and in the interests of equity, it should be resourced according to local need. We aimed to describe spatially the burden of chronic conditions and primary medical care funding in England at a low geographical level, and to measure how much variation in funding is explained by chronic condition prevalence and other patient and regional factors. Methods We used multiple administrative data sets including chronic condition prevalence and management data (2014/15), funding for primary-care practices (2015-16), and geographical and area deprivation data (2015). Data were assigned to a low geographical level (average 1500 residents). We investigated the overall morbidity burden across 19 chronic conditions and its regional variation, spatial clustering and association with funding and area deprivation. A linear regression model was used to explain local variation in spending using patient demographics, morbidity, deprivation and regional characteristics. Results Levels of morbidity varied within and between regions, with several clusters of very high morbidity identified. At the regional level, morbidity was modestly associated with practice funding, with the North East and North West appearing underfunded. The regression model explained 39% of the variability in practice funding, but even after adjusting for covariates, a large amount of variability in funding existed across regions. High morbidity and, especially, rural location were very strongly associated with higher practice funding, while associations were more modest for high deprivation and older age. Conclusions Primary care funding in England does not adequately reflect the contemporary morbidity burden. More equitable resource allocation could be achieved by making better use of routinely available information and big data resources. Similar methods could be deployed in other countries where comparable data are collected, to identify morbidity clusters and to target funding to areas of greater need.

History

Publication status

  • Published

File Version

  • Published version

Journal

BMC Medicine

ISSN

1741-7015

Publisher

BioMed Central

Issue

1

Volume

16

Page range

1-13

Article number

a19

Department affiliated with

  • Primary Care and Public Health Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2018-02-21

First Open Access (FOA) Date

2018-02-21

First Compliant Deposit (FCD) Date

2018-02-21

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