Achieving geographic equity in the Portuguese hospital financing system.

The Portuguese health care system is based on a national health service structure. The Portuguese government has with various statements over time shown that it is seeking some kind of geographical equity but this has never been clearly defined. There are wide inequalities in the distribution of hospital resources in Portugal with marked concentration in urban coastal areas and little information. The objective of the research described in this thesis is to develop methods to inform the allocation of resources to Portuguese hospitals so that this can be made more equitable in both current and capital spending. The methods used are a combination of methods already used in other countries and new methods to address two questions. First, to measure inequities in hospital care in terms of capital, finance and utilisation using capitation formulas. These formulas are constructed using: a multiplicative model to measure need for hospital care; a multilevel model to estimate unavoidable costs and to disentangle allocative inefficiencies of hospital care; and a flow demand model to predict hospital geographical utilisation and to compute cross-boundary flows. Second, to indicate how redistribution of hospital supply will best improve equity of utilisation and access, using location-allocation models that were designed to consider alternative policy objectives and account for patients' choice of hospitals