PubMed Health⌕ Search

Biomedical subjects

Gavin Mooney

Publications and source records attributed to Gavin Mooney.

15 recordsLinked to original sources
PubMed2005

Communitarian claims and community capabilities: furthering priority setting?

Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.

Attitude to Health↗
PubMed2004

Australian public health: some history lessons from South Africa.

OBJECTIVE: To draw historical parallels between inequalities in South Africa and Australia and their implications for public health, and especially Aboriginal health, in the latter. METHODS: To use the work of Terreblanche in South Africa and Houston in Australia to demonstrate the relevance of past inequalities to some of today's health problems. RESULTS: Economic structural issues remain crucial to the development of and the future health of these two countries. There are more grounds for hope for a more equal society in South Africa than there are in Australia. CONCLUSIONS: South Africa has made some attempt to face its past while Australia has not. Attempts to kill off Aboriginal culture continue. Aboriginal health will only improve when white Australia is prepared to face its 'black' past and move beyond the racism and indifference that surround Aboriginal affairs. The neo liberalism of both countries serves their disadvantaged populations ill.

Australia↗
PubMed2004

An alternative approach to resource allocation: weighted capacity to benefit plus MESH infrastructure.

This article outlines an approach to resource allocation in healthcare that embraces the concepts of 'capacity to benefit' and management economic social and human (MESH) infrastructure. Health service jurisdictions differ in terms of their capacities to produce benefits for the people they serve. This is for three reasons: (i) some populations already have relatively good health, so the capacity to benefit further is limited compared with others; (ii) even where the health levels of two populations are similar, one population's health problems can be more amenable to health service interventions, i.e. its capacity to benefit from healthcare interventions is greater; and (iii) even where both the health levels and the health problems are similar, one health service may be better placed or better equipped to deliver benefit to its population than the other. In the case of (iii), the capacity to benefit is inhibited because it lacks the necessary MESH infrastructure to deliver health benefits to its population. The approach to resource allocation outlined in this article differs from the more conventional approaches. While resource allocation working party (RAWP)-type formulae concentrate on allocating resources primarily according to the size of the problem (often called heath need and measured in terms of some assessment of the amount of sickness in a population), the starting point with weighted 'capacity to benefit' plus MESH is to ask what good or benefit is sought in allocating resources. In so far as there are variations in the abilities of different authorities by way of MESH, this can result in uneven implementation of health service interventions and consequent inequities and inefficiencies for the relevant populations. There is a need to address this problem of variation through providing support to those jurisdictions that are deficient in these abilities. The building of MESH infrastructure is to be seen as a major plank in any equity strategy, as it may well be the neediest jurisdictions that are most often lacking in MESH. The lack of MESH in these communities will then exacerbate inequities in service delivery.

Cost-Benefit Analysis↗
PubMed2003

A politico-economic analysis of decision making in funding health service organisations.

From a normative perspective, conventional economic analysis is often used to establish a framework in which social objectives can be built into the decision-making process. The health economics literature, however, tends to overlook the positive analysis of decision making--often assuming particular social objectives that may or may not correspond with reality. This perhaps explains why exercises in health economics priority setting on occasions break down. This study is a positive analysis of group decision making. It examines the process of deliberating upon proposed changes to funding arrangements across Divisions of General Practice in Queensland, Australia. Existing levels of funding had, for a number of years, largely been determined by an allocation formula. The motivation for this study was a perceived inequity created by the long-term under-funding of smaller (resource poor or 'marginal') Divisions. The challenge in this project was that any change in funding arrangements required the support of all the Divisions but also would potentially create 'winners' and 'losers'. Decision making within such an institutional context was rendered a zero sum game. This paper documents a consultative process whereby the relevant stakeholders, with clear interests in any decision, were asked to participate in deliberations as to how such a problem should be tackled. The objective was, in the face of adverse incentives, to derive recommendations for addressing existing shortfalls experienced by some of these Divisions. The process involved encouraging relevant players to take into consideration the global allocation issues and to move beyond their localised interests. The results indicate that such a process can be effective in not only generating the necessary goodwill to enable such group decision making, but also in establishing a more realistic set of policy recommendations.

Consensus↗
PubMed2003

Inequity in Australian health care: how do we progress from here?

OBJECTIVE: To determine some of the key problems in pursuing equity in Australian health care and to identify some of the ways of overcoming these problems, particularly in Aboriginal and Torres Strait Islander health care. METHODS: To identify and debate the key equity issues particularly related to Aboriginal and Torres Strait Islander health care but also with respect to public versus private and rural/remote versus metropolitan. RESULTS: Political leadership and political will plus a more compassionate, less complacent society are crucial. CONCLUSIONS AND IMPLICATIONS: Political leadership is needed that can inspire a more compassionate society and which reflects better the informed values of the Australian people, adopting a communitarian paradigm. There is a need for a 'health care constitutional convention' to allow the values of the populace with respect to equity to be elicited and to ensure that voices of the disadvantaged are heard. In the specific context of Aboriginal and Torres Strait Islander health care, there is a need first to recognise and thereafter break down the racism that exists in many Australian institutions.

Australia↗
PubMed2002

The Danish health care system: it ain't broke... so don't fix it.

The organisation and financing of the Danish health care system was evaluated within a framework of analysis of strengths, weaknesses, opportunities and threats (a SWOT analysis) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a 1 week-visit to health care authorities, providers and key persons. This paper includes the main findings by one of the panel members. The international competition 'wave' passed by Denmark, and the Danish might rightly say 'thank goodness'. Funding is very largely public and there is a single dominant authority, i.e. the county, which makes planning easier. Low levels of patient payments and the smaller size of the private sector reflect Danish 'solidarity' and promote equity. Planning is good. Exceptions to this are the over-concern with hospital waiting lists and the flirting with DRG based funding. Greater investment in planning approaches would make the system yet better. The GP blended remuneration system with capitation and fee for service is a major strength. The fact that the system has such potential for technical and allocative efficiency and also equity but is not fully exploited suggests the need for more investment in health services research. While there is scope for improving the health care system in Denmark, the rest of the world has as much to learn from the Danes as the Danes have from the rest of the world.

Community Participation↗
PubMed2002

Staking a claim for claims: a case study of resource allocation in Australian Aboriginal health care.

There have been numerous ways in which the notion of equity has been put forward in the literature. This reflects the fact that equity is essentially driven by values and is therefore subject to individual interpretation and preferences. Deciding between these various value judgements is however outside the scope of economic analysis, as conventionally defined. This poses a problem for the examination of issues of resource allocation in Aboriginal health services in Australia, where equity, very clearly, has a role to play. One possibility for moving forward on this issue is the adoption of a 'claims' approach where the emphasis is on the explicit recognition of the values to be employed in the 'equitable' allocation of resources. This involves teasing out the principles by which, under various approaches, resources are allocated differentially across groups (e.g. under resource allocation formulae, the criterion of 'need' as measured by SMRs can be viewed to be a basis for a 'claim' over resources). The commonly cited 'basic needs approach' is then used in the paper as a case in point to illustrate how such underlying principles may be identified and then assessed. In relation to the issue of equity in Aboriginal health services, there are a number of possible standards for equity which seem to have a significant degree of community acceptance. The paper discusses ways in which they can be applied to the problem of deciding how to allocate resources in Aboriginal health.

Australia↗
PubMed2002

Equity in health care from a communitarian standpoint.

Equity in health and health care is an important issue. It has been proposed that the pursuit of equity in health care is being hampered by the dominance of individualism in health care practices. This paper explores the way in which communitarian ideals and practices might lend themselves to the pursuit of equity. Communitarians acknowledge, respect and foster the bonds that unite and identify communities. The paper argues that, to achieve equity in health care, these bonds need to be recognised and harnessed rather than ignored. The notion of individual autonomy in the context of the community is examined. Alternative concepts of autonomy--social autonomy and community autonomy--are seen to be more respectful and nurturing of both the individual and the community. Moreover, these concepts appear desirable for the pursuit of health care equity goals. The paper concludes with some thoughts about how equity in Australia's health care system can reasonably progress within a communitarian vision. Disadvantaged communities are discussed throughout, in particular, Australian Aboriginal communities.

Australia↗
PubMed2002

Public health, political morality and compassion.

OBJECTIVE: To put the case that public health professionals have a responsibility to foster a more informed, autonomous community. METHOD: To argue that the current Australian Federal Government is failing to provide the impetus for building a compassionate society, particularly with respect to social justice for asylum seekers and Aboriginal people. RESULTS: There is a need for public health professionals to assist in promoting an informed debate about what it means to be a minimally decent Australian. CONCLUSIONS AND IMPLICATIONS: Education of the citizenry and by the academy in public debate and public debating is the lifeblood of democracy. This is the ethical goal of public health.

Australia↗
PubMed2002

Priority setting in mental health services.

This paper sets out an approach to priority setting in mental health services, built around programme budgeting and marginal analysis (PBMA). The paper also discusses the question of building in equity, especially the concept of vertical equity which, given the relative neglect of mental health services when resources have been allocated in the past, might serve as a mechanism for redressing the imbalance in resource allocation to the mentally ill. Beyond that the importance of eliciting community values to aid priority setting in mental health services is highlighted, particularly with respect to the principles underlying the mental health services or what one might call 'the nature of the good' that society wants from its mental health services. While it can be argued that trying to ascertain these principles or the nature of the good applies in all health services--and that is not disputed here--in mental health there is yet more need for clarification than in many other, indeed most other, health services. The need to exercise value judgments is emphasised. There is also a word of caution on the dangers of over-reliance on waiting for perfect evidence. Finally the paper considers how best to operationalise priority setting in mental health services, and perhaps make it less of a nightmare for mental health service planners than it currently seems to be.

Australia↗