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Modelling geographical variation in supply and demand influences on the use of health care in England

Faculty of Biology, Medicine and Health

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Dr Laura Anselmi , Prof M Sutton Applications accepted all year round Self-Funded PhD Students Only

About the Project

Understanding the drivers of geographic variation in health care expenditure and utilization is key in identifying needs for health care and planning equitably the distribution of health care supply. Assuming that demand for care is driven by need, need can be measured by service use of attributable to demand factors. More conservative approaches rely on area level indicators and characteristics to identify the relative importance of demand and supply factors in determining the observed patterns of utilization. In England such analytical approaches have been developed over time to allocate resources to local health organization using area level data and linked national patient level. More recent approaches use person level data and track movers longitudinally across regions. The evidence available to date suggests that both demand and supply characteristics contribute to variation in health care use and expenditure across geographic areas, but the relative contributions vary across countries and regions and partly depending on the method used.

This PhD aims at measuring the relative contributions of demand and supply factors to regional variation in health care use and expenditure in England. The specific objectives include: developing and applying alternative empirical strategies based either on the methods currently used to produce resource allocation formulae or on tracking patients over time; comparing results and understanding what is driving differences between approaches; and determining the suitability of each method for different analytical purposes. Results will be helpful to advance methods for equitable resource allocation.
The project will require the application of advanced micro-econometric techniques to linkable national patient level data available over time

The supervisory team combines extensive research experience in the analysis of equity in health care use and expenditure using national level administrative data with a focus on regional variation, and a track record of successful supervision of doctoral students.

Training/techniques to be provided:
The candidate will receive training in: data cleaning, management, linkage and analysis of very large national datasets, with a particular focus on patient level data; measurement of health care use and expenditure and equity and inequality in health and health care; impact evaluation and causal inference econometrics and statistical techniques.

Entry Requirements:
Candidates are expected to hold (or be about to obtain) an excellent quality Masters degree (or equivalent) in Economics or Health Economics. For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website ( Informal enquiries may be made directly to the primary supervisor.

For international students we also offer a unique 4 year PhD programme that gives you the opportunity to undertake an accredited Teaching Certificate whilst carrying out an independent research project across a range of biological, medical and health sciences. For more information please visit

Funding Notes

Applications are invited from self-funded students. This project has a Band 1 fee. Details of our different fee bands can be found on our website ( For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (

As an equal opportunities institution we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.


Finkelstein A, Gentzkow M, Williams H. (2016), Sources of geographic variation in health care: evidence from patient migration, Q J Econ. 2016 Nov;131(4):1681-1726.

Moura, A., Salm, M., Douven, R. & Remmerswaal, M. (2019), Causes of regional variation in Dutch healthcare expenditures: Evidence from movers, Health Econ, 28(9): -.

Gravelle H, Sutton M, Morris S, Windmeijer F, Leyland A, Dibben C, Muirhead M. (2003), Modelling supply and demand influences on the use of health care: implications for deriving a needs-based capitation formula. Health Econ. 12(12):985-1004.

Morris S, Sutton M, Gravelle H. (2005), Inequity and inequality in the use of health care in England: an empirical investigation, Soc Sci Med. 60(6):1251-66.

Anselmi, L., Everton, A., Shaw, R., Suzuki, W., Burrows, J. N., Weir, R., Tatarek-Gintowt, R., Sutton, M. & Lorrimer, S. (2019), "Estimating local need for mental health care to inform fair resource allocation within the NHS in England: cross-sectional analysis of national administrative data linked at person-level", British Journal of Psychiatry, 8:1-7. doi: 10.1192/bjp.2019.185.
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