ABSTRACT
This chapter shows how health care expenditure can be broken down into a matrix of specialities and age groups, using data from a former District Health Authority in East Sussex. The cost implications of certain diseases can be followed through matrix, examining the potential for disinvestment and reinvestment, and tracking consequences of any shifts which might occur. Coronary heart disease is taken as a worked example of how resource expenditure was tracked through matrix and how an innovative scheme for reducing coronary disease risk factors was established. Separation of the purchasing and providing roles in health care has created an opportunity for imaginative thinking and radical change in the way services are delivered. Health gain was introduced through the Department of Health epidemiological reviews and guidelines on health needs assessment, the publication of the Health of the Nation Strategy, the recognition of an outcomes focus, rather than process and the public and media debate about epidemiology, economics, priorities, and rationing.
