Health premium for good commissioning criticised by experts

Authors of the influential Marmot report on public health said government plans to reward good commissioning with a health premium will disadvantage poorer areas and should be revised.

Health premium would reward richer areas at the expense of poorer ones
Health premium would reward richer areas at the expense of poorer ones
There is little evidence that the health premium will reduce inequalities and is likely to increase them, experts from the Marmot Review told the House of Commons health committee in London yesterday.

A leading health economics professor said the plans were ‘not fit for purpose’ in their current form.

The government proposes to pay a health premium to local authorities for delivering improvements in public health.

In March, public health expert Professor Alan Maryon-Davis of  King's College London, had warned the health premium could strip funds from clinical commissioning groups – formerly GP consortia – in deprived areas.

Now, Professor Peter Goldblatt, senior research fellow at University College London (UCL), who worked on the Marmot Review, told the public health inquiry that the premium will reward richer areas at the expense of poorer ones.

He said: ‘For the most affluent areas, achieving health gain is, in relative terms, the easiest. Conversely, areas of great disadvantage will put a lot of effort in, but in terms of achievement will achieve a lot less and get a lot less from the health premium.

‘The health premium risks, implemented in a very crude way, being regressive rather than progressive. More money going to the affluent areas and less to the least well off areas.’

Health economics Professor Stephen Morris of UCL said: ‘The health premium is not fit for purpose at the minute.’

He claimed that the concept was sound in principle and there is evidence increasing spending on public health can improve a population’s health.

But no allocation formula currently exists that would make this work, he said.

The panel, which also included Marmot Review project manager Dr Jessica Allen of UCL, agreed the premium must focus on disadvantaged areas and give greater incentives for areas with the hardest task to improve public health.

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