ArticleBMJ (Clinical research ed.)1996
Determining the size of a total purchasing site to manage the financial risks of rare costly referrals: computer simulation model.
Article in BMJ (Clinical research ed.), 1996. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Comparing the financial risk of bed-day and DRG based pricing types using parametric and simulation methods.Health care management science · 2003Article
- Is bigger better for primary care groups and trusts?BMJ (Clinical research ed.) · 2001Review
- Setting budgets for general practice in the new NHS.BMJ (Clinical research ed.) · 1999Article
- Evaluating primary care groups.The British journal of general practice : the journal of the Royal College of General Practitioners · 1998Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the financial risks of 15 categories of rare costly referrals for total purchasing sites of different population sizes.
designComputer simulation of 100 fund years assuming Poisson distribution of referrals.
settingBritish general practices that have opted to become total purchasing sites. Referral rates and price estimates were supplied by South and West Devon Health Commission.
main outcome measuresVariation in referral costs to purchasers in relation to size of risk pool (person years at risk).
resultsRandom variation in referral costs increased as the size of the risk pool decreased. Variation increased greatly below 30,000 person years. The mean simulated cost of the referral categories considered was 2.8% of total NHS hospital and community service costs, and the maximum simulated cost for 7000 person years was 6.8%. Simulated variation was robust to assumption about prices and referral rates for specific types of referral.
conclusionRare costly referrals seem unlikely to bankrupt total purchasing sites. The management of risk is not in itself justification for total purchasing to be based in several general practices in order to generate large populations. There are other ways of managing risk. Sites can easily explore options by simulations using local referral rates and prices.
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