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The British Journal of Psychiatry (2000) 177: 267-274
© 2000 The Royal College of Psychiatrists

Expenditure on mental health care by English health authorities: a potential cause of inequity

JONATHAN BINDMAN, MRCPsych, GYLES GLOVER, MRCPsych, DAVID GOLDBERG, FRCPsych and DANIEL CHISHOLM, MSc

Institute of Psychiatry, London

Correspondence: Dr Jonathan Bindman, Clinical Lecturer, Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Declaration of interest None.

Background The York resource allocation formula includes a calculation of the amount needed to purchase mental health services equitably in each health authority in England. However, the amount which is actually spent on services is at the discretion of the authority.

Aims To compare expenditure on mental health services with allocation, and test the hypothesis that differences between them are to the disadvantage of services in deprived areas.

Method A comparison of routine expenditure and allocation data, and linear regression modelling of the ratio of expenditure to allocation.

Results The ratio of expenditure to allocation varies widely. Relative underspending occurs more frequently in deprived areas, although not in the four inner-London health authorities.

Conclusions The intentions of the York formula are not achieved in practice. The implications of the formula for mental health should be made explicit to health authorities, and shortfalls in mental health expenditure relative to allocation should be justified at a local level.




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