Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-04T11:34:26.808Z Has data issue: false hasContentIssue false

Amateurs Confronting Specialists: Expenditure on AIDS in England

Published online by Cambridge University Press:  28 November 2008

B. M. Craven
Affiliation:
Business School, University of Northumbria
G. T. Stewart
Affiliation:
Public Health, University of Glasgow
M. Taghavi
Affiliation:
Economics, University of Northumbria

Abstract

Present public policy in Britain towards the Acquired Immune Deficiency Syndrome (AIDS) funding is unusual if not exceptional; first because the funding is earmarked and second because no other area of medicine receives such high levels of resources. This paper examines the cause of AIDS and the likely trend of new cases and hence future resource demands upon the NHS. This paper offers four explanations for massive ‘ring-fenced’ AIDS expenditure of public revenue. The distribution to and allocation of those monies by Regional Health Authorities is analysed. It concludes that there is very little rationale for this, especially when alternative uses of funds are considered. Furthermore the politics of incrementalism indicates that what has already become a major misuse of public funds is likely to continue in the foreseeable future.

Type
Articles
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Acquired Immune Deficiency Syndrome (AIDS) in England and Wales to the end of 1992 (1992) Report of a Working Group Convened by the Director of the Public Health laboratory service, London, HMSO.Google Scholar
Agency for Health and Welfare Services (1985) California, AIDS in San Francisco, California Morbidity Reports, November 8,Google Scholar
Agency for Health and Welfare Services; Bi-weekly Reports on Communicable Diseases, 1985–1922, 1992.Google Scholar
Barre-Sinoussi, F. et al. (1983) Isolation of a T-Lymphotropic Retrovirus from a Patient at Risk from Acquired Immune Deficiency Syndrome (AIDS), Science, 220, 868871.CrossRefGoogle ScholarPubMed
Bregman, J. & Langmuir, A., (1990) Farr's Law Applied to AIDS Projections, Journal of the American Medical Association, 264, 9, 1104.CrossRefGoogle Scholar
Butler, J.R.G. (1990) The Economic Nature of AIDS and Implications for Public Policy, Working Papers in Economics and Econometrics, Australian National University, 222, December.Google Scholar
Centers for Disease Control (1987) Revision of the CDC Surveillance Case Definition for AIDS, Morbidity and Mortality Weekly Review, 36, 35155.Google Scholar
Centers for Disease Control, 1992 (1993) Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS among Adolescents and Adults, Morbidity and Mortality Weekly Report, 41, 119; with addendum to the Proposed Expansion of the AIDS Surveillance Case Definition; October, Atlanta, Georgia.Google Scholar
Courouce, A., Muller, A. and Richard, B. (1986) False positive Western Blot Reactions to HIV-i in Blood Donors, Lancet, 2, 921922.CrossRefGoogle Scholar
Cox, D.R., Anderson, R. M. and Hillier, H. C. (Eds) (1989) Epidemiological and Statistical Aspects of the AIDS Epidemic, Phil Trans S Soc London (B), 325, 37187.Google Scholar
Craven, B. M. and Smith, C. (1993) The Internal Market of the NHS: Some Early Observations from the Freeman Hospital, Newcastle upon Tyne, Journal of Management in Medicine, Vol. 7, No. 4, PP. 514.CrossRefGoogle Scholar
Craven, B. M. and McNulty, M. B. (1994) Management Training and Development Expenditure: Perspectives from Auditing, Economics and Human Resource Management, Managerial Auditing Journal (in press).CrossRefGoogle Scholar
Culyer, A. J. (1980) The Political Economy of Social Policy. London: Martin Robertson.Google Scholar
Culyer, A. J. (1988) Inequality of Health Services is, in General, Desirable, Acceptable Inequalities, Institute of Economic Affairs Health Unit Paper, pp. 3147, No. 3.Google Scholar
Dalton, H. (1936) Public Finance, 9th ed., p. 182, London: Routledge.Google Scholar
Davy, R. T., Dayton, L. R., Metcalf, J. A. et al. (1992) Intermediate WB patterns in a Cohort at High Risk for HIV Infection, Journal of Clinical Immunology, 12, 3, 185192.Google Scholar
Day, P. and Klein, R. (1989) Interpreting the Unexpected: the case of AIDS policymaking in Britain, Journal of Public Policy, Vol. 9, No. 3, pp. 337353.CrossRefGoogle Scholar
Department of Health and the Welsh Office (1988) Short Term Prediction of HIV Infection and AIDS. Report of a working group (Chairman: Sir D. Cox) London: HMSO.Google Scholar
Deran, E. (1965) Earmarking and Expenditure: a survey and a new test, National Tax Journal, December, 357.CrossRefGoogle Scholar
Gottlieb, M. S. (1981) Pneumocystis Carinii and Mucosal Candidiasis in Previously Healthy Homosexual Men, New England Journal of Medicine, 305, 24.CrossRefGoogle ScholarPubMed
International Classification of Diseases. 10th Edition (1992) Geneva: WHO.Google Scholar
Institute of Internal Auditors – United Kingdom (1986) MIIA Distance Learning Course, Local and Central Government Services Unit 8, p. 26.Google Scholar
Jackson, P. M., and Palmer, A. (1989a) First Steps in Measuring Performance in the Public Sector. Public Finance Foundation and Price Waterhouse.Google Scholar
Jackson, P. M. and Palmer, A. (1989b) Extending the Frontiers of Performance Measurement: How Much Further Can We Go? in Beeton, D. (ed), Performance Measurement: Getting the Concepts Right, Public Finance Foundation, Discussion Paper 18.Google Scholar
Kent Weaver, R. (1986) The Politics of Blame Avoidance, Journal of Public Policy, Vol. 6, No. 4, pp. 37398.Google Scholar
Lundberg, G. D. (1988) Serological Diagnosis of HIV Infection by Western Blot Testing, Journal of the American Medical Association, 260, 674679.Google Scholar
McCarthy, M. and Layzell, S. (1993) Funding Policies for HIV and AIDS: time for change, British Medical Journal Vol. 307, 7 August 367379.CrossRefGoogle ScholarPubMed
Meyer, K. B. and Parker, S. G. (1987) Screening for HIV: Can We Afford the False Positive Rate? New England Journal of Medicine, 317; 238241.CrossRefGoogle ScholarPubMed
Midthun, K., Garrison, G., Clements, M. L. et al. (1990) Frequency of Indeterminant Western Blot Tests in Healthy Adults at Low Risk for HIV Infection, Journal of Infectious Diseases, 162, 1379–82.CrossRefGoogle Scholar
Monks Inquiry Report (1988) Report of the Working Group to examine workloads in GUM clinics, November.Google Scholar
Mortimer, P. P. (1991) The Fallability of HIV Western Blot, Lancet, 37, 286287.CrossRefGoogle Scholar
Musgrave, A. and P. B., (1980) Public Finance in Theory and Practice. New York: McGraw-Hill, 3rd. ed., p. 242.Google Scholar
Philipson, T. J. and Posner, R. A. (1993) Private Choices and Public Health: the AIDS epidemic in an economic perspective, Harvard University Press, Cambridge Mass., London, England.Google Scholar
Public Health and Laboratory Services and Communicable Diseases (Scotland Unit), 1992.Google Scholar
Root-Bernstein, R. S. (1993) Rethinking AIDS, New York: Free Press.Google Scholar
Rose, R. (1987) The Political Appraisal of Employment Policies, Journal of Public Policy, Vol. 7, No. 3, pp. 285305.CrossRefGoogle Scholar
Shilts, R. (1987) And the Band Played On: Politics, People and the AIDS Epidemic. Penguin Books.Google Scholar
Stewart, G. T. (1992a) Epidemiology and Transmission of AIDS, The Society of Public Health Official Handbook and Members List, pp. 1924.Google Scholar
Stewart, G. T. (1992b) Changing Case Definition for AIDS, Lancet, 340, 1414.CrossRefGoogle ScholarPubMed
Stewart, G. T. (1993) Errors in predictions of the incidence and distribution of AIDS, Lancet, 341, 898.CrossRefGoogle ScholarPubMed
Teja, R. S. and Bracewell-Milnes, B. (1991) The Case for Earmarked Taxes. London: Institute of Economic Affairs.Google Scholar
US Department of Health and Human Services, HIV/AIDS Surveillance, 1982–1992. Centers for Disease Control, Atlanta, Ga.Google Scholar
Weeks, J. (1989) AIDS: The Intellectual Agenda, in AIDS: Social Representations, Social Practices. Falmer Press, 121.Google Scholar
Weisbrod, B. A. (1961) Economics of Public Health. Philadelphia: University of Pennsylvania Press.CrossRefGoogle Scholar
Whelan, R. (1991) The AIDS Scandal, Economic Affairs, June.CrossRefGoogle Scholar
Wildavsky, A. (1975) Budgeting: A Comparative Theory of Budgetary Processes, Little, Brown and Co.Google Scholar
Williams, A. (1985) Economics of Coronary Artery By-pass Grafting, British Medical Journal, 291, 326329.CrossRefGoogle Scholar
Williams, A. (1992) Cost Effectiveness Analysis: Is It Ethical?, Journal of Medical Ethics, 18, 1, 712.CrossRefGoogle Scholar
Williamson, O. E. (1973) Markets and Hierarchies: Analysis and Anti-Trust Implications, Free Press, New York.Google Scholar
World Health Organisation (1992) Global Programme on AIDS. Current and Future Dimensions of the HIVIAIDS Pandemic. A Capsule Summary. Geneva: WHO.Google Scholar