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At least 37 records · Page 2Linked to original sources
PubMed1991

Differences in hospital resource allocation among sick newborns according to insurance coverage.

OBJECTIVE: To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services. DESIGN: Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition. SETTING: All California civilian acute-care hospitals. PATIENTS: Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751). MAIN OUTCOME MEASURES: Length of stay, total charges, and charges per day. RESULTS: Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured. CONCLUSIONS: The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.

California↗
PubMed1987

Resource allocation in health care: the allocation of lifestyles to providers.

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1990

A methodology for resource allocation in health care for South Africa. Part II. The British experience and its relevance to South Africa.

This second article in the series on resource allocation in health care, argues for a formula-based method of resource allocation in South Africa. The model employed in England since 1976 and its application in a number of developed and developing countries is reviewed. The international experience is related to South African conditions and the principal elements necessary for a formula to achieve greater spatial equity in South African health-resource distribution are discussed.

Delivery of Health Care↗
PubMed1975

REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic.

The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.

Contraceptives, Oral↗
PubMed1978

Changing patterns of resource allocation in a London teaching district.

The health plans of the Tower Hamlets district management team were studied to determine what effects the report of the Resource Allocation Working Party and the White Paper "Priorities in the Health and Social Services" have had on resource allocation in a teaching district. The study showed that at present acute services are allocated a greater proportion of the district budget than occurs nationally, while geriatrics, mental health, and community services receive proportionately less. In the next three years spending on acute services is expected to decrease, while spending on geriatric facilities and community services will increase. Nevertheless, cuts in acute services will take place mainly through a reduction in the number of beds serving a community function, concentrating all acute services in the teaching hospital. Services to the district might be better maintained by creating a community hospital to meet the needs of patients who would otherwise need to be accommodated in acute beds with unnecessarily expensive support services.

Community Health Services↗
PubMed1992

Resource allocation problems and health services for the elderly.

The provision of appropriate health support services for the elderly has increased in importance because of the trend towards aging populations in Europe and other developed regions. Health service resource allocation models and their roles in health service systems, which are also changing to reflect changing needs for the elderly, are discussed in this article. Different types of economic and health care delivery systems are examined, particularly those leading towards decentralization, consumer participation and "deinstitutionalization". A promising resource allocation approach--the "balance-of-care" approach--is described in some detail. This and other potential approaches make it possible to identify areas which hold promise for crossnational research.

Aged↗
PubMedDate not supplied

Severity of illness and resource allocation in DNR patients in ICU.

This study examined the differences in severity of illness and resource allocation between patients with do-not-resuscitate (DNR) orders and non-DNR patients in intensive care units. Severely ill intensive care patients with DNR orders continued receiving aggressive medical care following cardiac or respiratory arrest. The continued use of advanced therapies for DNR patients raises important questions about the use of costly intensive care resources.

Adult↗
PubMed2024

Variable resource allocation pattern, biased sex-ratio, and extent of sexual dimorphism in subdioecious Hippophae rhamnoides.

Evolutionary maintenance of dioecy is a complex phenomenon and varies by species and underlying pathways. Also, different sexes may exhibit variable resource allocation (RA) patterns among the vegetative and reproductive functions. Such differences are reflected in the extent of sexual dimorphism. Though rarely pursued, investigation on plant species harbouring intermediate sexual phenotypes may reveal useful information on the strategy pertaining to sex-ratios and evolutionary pathways. We studied H. rhamnoides ssp. turkestanica, a subdioecious species with polygamomonoecious (PGM) plants, in western Himalaya. The species naturally inhabits a wide range of habitats ranging from river deltas to hill slopes. These attributes of the species are conducive to test the influence of abiotic factors on sexual dimorphism, and RA strategy among different sexes. The study demonstrates sexual dimorphism in vegetative and reproductive traits. The sexual dimorphism index, aligned the traits like height, number of branches, flower production, and dry-weight of flowers with males while others including fresh-weight of leaves, number of thorns, fruit production were significantly associated with females. The difference in RA pattern is more pronounced in reproductive traits of the male and female plants, while in the PGM plants the traits overlap. In general, habitat conditions did not influence either the extent of sexual dimorphism or RA pattern. However, it seems to influence secondary sex-ratio as females show their significant association with soil moisture. Our findings on sexual dimorphism and RA pattern supports attributes of wind-pollination in the species. The observed extent of sexual dimorphism in the species reiterates limited genomic differences among the sexes and the ongoing evolution of dioecy via monoecy in the species. The dynamics of RA in the species appears to be independent of resource availability in the habitats as the species grows in a resource-limited and extreme environment.

Hippophae↗
PubMed1989

Resource allocation decisions in critical care nursing.

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.

Beneficence↗
PubMed1990

Stimulus miscuing and dishabituation: electrodermal activity and resource allocation.

The present research investigated the effects of miscuing a shock stimulus on dishabituation of the skin conductance response and on the allocation of processing resources. In both experiments, a control group received 21 S1-S2 pairings intermixed with 23 S3-alone presentations. For the experimental group, S2 was miscued on trials 11 and 22 by its presentation following S3. In Experiment 1 (N = 48), S2 was a shock that was either "clearly discernible" or "uncomfortable but not painful". The results indicated increased electrodermal responding when S2 was miscued by S3 and subsequent dishabituation when S2 again followed S1 on the next trial. Miscuing produced dishabituation with both a high- and low-shock S2. A continuous measure of S2 expectancy revealed that expectancy of S2 in the presence of S1 declined as a result of miscuing. Experiment 2 (N = 36) employed reaction time to a white noise probe stimulus as the dependent variable. The critical data came from probes presented 300 ms following S2 onset on the S1-S2 trial immediately following miscuing. They indicated that miscuing produced slowed reaction time to probes presented during S2 on the following S1-S2 trial. Thus, the miscuing of S2 by S3 appears to result in an increase in processing resources devoted to S2, even when S2 is presented in its usual position following S1. The results are discussed in terms of current theories of associative learning.

Adult↗
PubMed1989

St Bartholomew's resources allocation scheme.

This scheme has three main features: it relates the output of work and materials from the department to the funding input (resource allocation), it enables the funding bodies to determine the level of output they are willing to support and it creates spare capacity to permit income generation either through charging for work done in excess of allocations made under the scheme or by attracting outside business. The system devolves upon the work unit as a measure of resource and this is made up of a combination of materials and time depending on the product. Derivation of work unit cost is given as a function of all reckonable operating costs of the department. Different profit margins may be applied according to category of request. Income is returnable to the funding bodies in the same ratio as their original provision to the service (for the current year of operation) after a deduction for reinvestment. The scheme allows for central funding to be progressively reduced to zero.

Cost Allocation↗
PubMed1986

Resource allocation under poor growth conditions. A major role for growth substances in developmental plasticity.

This article argues that the basic function for growth substance is resource allocation under poor growth conditions. The following scheme is suggested. Plants in the wild frequently suffer a paucity of resources which result from interplant competition and ecological and local environmental variation. The strategy adopted by many plants particularly ruderals (from which crops may have evolved) to help mitigate these problems is phenotypic plasticity; the growth of the plant body is adjusted to best exploit the scarce resources and help achieve desirable growth and reproductive goals. Phenotypic plasticity requires decisions to be made concerning the diversion of scarce growth resources to one facet of development rather than another; for example, to height or leaf area rather than thickness; or, between tissues, stem rather than leaves. Growth substances are coupled to these individual facets of development. They represent a simple way in which the extent of resource diversion can be controlled. Cells in specific tissues acquire sensitivity to particular growth substances at a stage in their development when environmental variability often necessitates choices to be made. This acquisition of ontogenetic sensitivity may be all or none. It may reflect acquisition of receptor proteins coupled to specific metabolic events. However in well-nourished plants these phases of development are relatively insensitive to changes in the level of the growth substance/receptor complex. Cells become more sensitive under certain well-defined but specific circumstances, characterized by the general term, poor growth conditions. These are produced by imbalances in one or more of the major environmental (nutritional) requirements for growth, light, nitrogen, water and oxygen. Imbalance in one or more of these produces characteristic and far-reaching metabolic and protein synthesis changes which normally constrain the synthetic processes for growth but amplify metabolic events coupled to growth substances. It is the function of growth substances to circumvent some of these metabolically constraining steps and by applying a constant stimulus to one specific aspect of growth or metabolism permit continued development. The additional input of growth substances into particular facets of development ensures the better maintenance (protection) of that character when competition for resources inside the plant is severe. However competition for scarce resources ensures that continuation of one growth aspect generally leads to relative depletion of others.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗
PubMed1989

Resources and dual-task performance; resource allocation versus task integration.

This study aims at contributing to the explanation of dual-task performance in terms of either resource allocation or of task interference and integration. Twenty-four subjects carried out, single and in combination, a motor interval production task and a perceptual target detection task on the basis of combined memory and display search. The demands of the target detection task were varied by increasing or decreasing the presentation rate of successive search displays. Furthermore, the presentation rate was either constant or variable. The dual-task condition had a negative effect on interval production, the extent of which was unaffected by either rate or variability of display presentation. This means that there was no evidence for synchronizing interval production with display presentation, so that the major opportunity for task integration did not substantiate. It is suggested that the two tasks use different resource pools in addition to a common mechanism, the limited capacity of which causes a general interference in dual-task conditions.

Adolescent↗
PubMed1980

Applying resource allocation formulae to constituent parts of the U.K.

If the health care budgets of the constituent nations of the United Kingdom in 1977-78 are added together and then redistributed on the RAWP formula there would be a significant movement of resources from Scotland and Northern Ireland and to England and Wales. The differential geographical allocation of resources within the U.K. is critically appraised, and it is argued that the higher resource allocations of the Thames regions and of Scotland and Northern Ireland have been examined imperfectly with polemics rather than analysis. However, the political costs are such that RAWP-type goals for the U.K. would be difficult to achieve.

England↗
PubMed1990

Depressive deficits in memory: processing initiative and resource allocation.

Hertel and Hardin investigated the effects of depressed mood states on recognition memory in three experiments. They report that mood effects on memory depend on the subjects' awareness of the task. Four issues are considered in this article: natural and induced moods, processing initiative, initiative versus resource allocation, and strategies.

Adult↗
PubMed1988

Ethics, economics, and endocarditis. The physician's role in resource allocation.

Medical decisions are increasingly shaped by financial considerations. Biomedical ethicists have encouraged the practicing physician to remain the agent of the individual patient, sometimes pitting physicians against health care institutions. The limitation of medical resources has given rise to the need for a clear conceptual basis for allocating scarce resources. The role of resource gatekeeper may be used to the indigent patient's disadvantage when the principles of triage are used incorrectly in situations of relative scarcity. To allocate limited resources fairly under changing policy and economic conditions, health care institutions should ensure that systematic processes, such as those of ethics consultants and committees, are readily available to help resolve problematic cases and policies. Physicians with clinical judgment and a primary commitment to patient care must assume active roles in these processes in order to build an ethically sound framework for clinical decision making in times of relatively scarce resources.

Adult↗
PubMed1989

The north-south divide in England: implications for health care resource allocation.

Published regional data show that the Standardized Mortality Ratio (SMR) for the northern half of England has recently increased from 113 to 115 per cent of the SMR for the south, and that the north is at least as disadvantaged in respect of morbidity and material deprivation and uses much less private medical care than the south. It is concluded that the north's share of National Health Service (NHS) resources should not be reduced, as it would be if recent proposals by the NHS Management Board were implemented; that a mortality index which gives different weights to deaths at different ages should possibly be used instead of the simple SMR to weight regional resource allocations for need; and that these allocations should also be weighted by some measure of the extent to which regional populations look to the NHS rather than to the private sector for hospital and specialist care.

England↗