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PubMed1990

A methodology for resource allocation in health care for South Africa. Part III. A South African health resource allocation formula.

A formula to calculate the proportion of the public sector budget that should be allocated to various geographical regions of South Africa is described. The formula is broadly classified into curative and preventive components. Using data that are routinely available, indices of need are calculated for each of these components. It is concluded that resource allocation on a macro level should closely approximate regional population distribution if cross-border flow of patients and additional teaching-hospital expenditure are ignored.

Age Factors↗

PubMed1996

The role of public opinion in drug resource allocation decisions.

Drug resource allocation decisions have a very real and direct impact on the public, due to cost and availability constraints resulting from these decisions. This presents an opportunity for public opinion to play an important role in influencing decisions that have far-reaching effects. Public opinion regarding pharmaceutical issues is influenced by drug companies, special interest groups, researchers and others. Since these groups often have conflicting goals, they may send contradictory messages to the public. In this article, we examine the issues of who comprises the public, how public opinion is influenced and what impact public opinion does and should have on drug resource allocation decisions. We emphasise that, for appropriate resource allocation decisions to be made, there is a continuing need to conduct high quality outcomes research and to continue the trend of increasing interest in how drugs are used rather than how much is sold or how much they cost. There is also a major role for pharmacoeconomic research to play in this issue, with a real need to make such research accessible and understandable by the public, including patients, physicians, pharmacists and policy makers, so that policy decisions can be based on such research.

Drug Therapy↗

PubMed1997

Bioethics for clinicians: 13. Resource allocation.

Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician's fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.

Canada↗

PubMed1993

Weighting in the dark: resource allocation in the new NHS.

National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper argues that the search for an empirically based resource allocation formula of high precision in the name of promotion of equity is largely fruitless given the impossibility of measuring the true need for, and costs of, providing health care, especially with the limited data available. The inclusion of measures of social deprivation is also poorly thought out. The availability of data from the 1991 census, which included a question regarding long-standing illness, together with the intention of the Department of Health to review the weighted capitation formula using this information may stimulate much work but little light. It is essential that the impact of resource allocation formulas is justifiable on grounds other than the composition of any particular formula.

Delivery of Health Care↗

PubMed1990

Resource allocation and the cost of quality.

The costs of producing quality medical care and the proper allocation of resources to assure quality are major contemporary concerns. Minimalists attempt to improve quality and lower costs through the application of the theory, "less is more." Bureaucracies make the same attempt through the denial of payments for "unnecessary" services. Governments and insurers try to "improve quality" by impeding the flow of new technology so that costs will be restricted (presumably allowing society better access to current care modalities). All impose regulations and requirements on medical practice. Each of these approaches is examined individually and substantial problems with their application in actual practice are illustrated. Genuine quality is not a cost or resource allocation problem. Quality is free.

Costs and Cost Analysis↗

PubMed2002

Hospital competition, resource allocation and quality of care.

BACKGROUND: A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. METHODS: To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. RESULTS: In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. CONCLUSIONS: This study raises concerns that cost reductions may be associated with increased mortality.

California↗

PubMedDate not supplied

How SmithKline Beecham makes better resource-allocation decisions.

Major resource-allocation decisions are never easy. For a pharmaceuticals company like SmithKline Beecham, the problem is this: How do you make good decisions in a high-risk, technically complex business when the information you need to make those decisions comes largely from the project champions who are competing against one another for resources? In 1993, the company experimented with ways of depoliticizing the process and improving the quality of decision making. In most resource-allocation processes, project advocates develop a single plan of action and present it as the only viable approach. In SB's new process, the company found an effective way to get around the all-or-nothing thinking that only reinforces the project-champion culture. Project teams were required--and helped--to create meaningful alternatives to current development plans. What would they do with more money? With less? With none at all? In another important departure from common practice, SB separated the discussion of project alternatives from their financial evaluations. In doing so, SB was able to avoid the premature evaluations that kill both creativity and the opportunity to improve decision making. The new process at SB has allowed the organization to spend less time arguing about how to value its R&D projects and more time figuring out how to make them more valuable. In the end, the company learned that by tackling the soft issues around resource allocation--such as information quality, credibility, and trust--it had also addressed the hard ones: how much to invest and where to invest it.

Decision Making, Organizational↗

PubMedDate not supplied

An object oriented decision support system for the planning of health resource allocation.

The health resource allocation problem is discussed in this paper. An object-oriented system, which consists of two parts is proposed and its implemented prototype is illustrated. The first part consists of a Geographical Information System which is able to acquire and store both geographical information regarding the territory under investigation and the socio-epidemiological information and the resource distribution in that moment on the same territory. The second part refers to the strategies and the relative algorithms carried out (using a Decision Support System) to obtain the best solution (allocation of new resources optimizing the cost/benefit ratio) after that the user has fixed a goal (e.g., the decrease of the incidence of a given disease) and has defined some constraints (e.g., a fixed budget, a given set of available resources, etc.). The object-oriented database stores different scenarios, depending on the different goals and constraints defined in input. A user friendly interface was also implemented.

Decision Making, Computer-Assisted↗

PubMed1992

Implications of basing health-care resource allocations on cost-utility analysis in the presence of externalities.

Cost-utility analysis is increasingly being advocated as a tool for helping to establish funding priorities among programs and services in the health-care sector. As currently conducted, however, cost-utility analysis is problematic as a basis for achieving allocative efficiency because it excludes externalities. The exclusion of externalities may bias program ranking in unpredictable ways, leading to a non-optimal allocation of resources. Consideration of externalities also raises a number of distributional issues for the evaluation of health services and highlights the important of developing economic evaluation methods that are consistent with the conceptual basis for allocating resources.

Canada↗

PubMed1996

Age bias, but no gender bias, in the intra-household resource allocation for health care in rural Burkina Faso.

Household survey data, time allocation data, and qualitative interviews were used to examine whether households allocate their resources for health care differently between age and gender groups. Households allocated significantly fewer resources to the health care of sick children compared to that of sick adults. In contrast there were no such differences with regard to gender. The underlying household rationale is to concentrate its resources spent for health care on productive members rather than to spread them equitably among all its sick members. While children are not productive, women were shown to contribute as much to household production as men, hence their health is valued equally with that of men. Unless we understand intra-household biases in resource allocation, policies will be undermined. Further research is needed to test the hypothesis for the households' preference of production maintenance over health maximization.

Adolescent↗

PubMed1987

Measuring morbidity for resource allocation.

The RAWP (Resource Allocation Working Party) report used population weightings based on standardised mortality ratios (SMRs) as a proxy measure of differences in morbidity (and therefore in the need for health care resources) that existed between geographical areas after allowing for the age and sex structure of their populations. The adequacy of SMRs as a proxy for morbidity has aroused controversy, particularly from RAWP losers in London, and is one of the main themes of the National Health Service Management Board's current review of RAWP. Critics have argued, firstly, that the nature of the relation between morbidity and mortality is unknown; and, secondly, that SMRs are incomplete because they fail to take account of the effect of social deprivation on the need for health care. As a result several alternative proxies for morbidity based on social indicators have been proposed. One of their principal drawbacks is that their use is justified by their relation to measures of use of services known to be affected by the prevailing level of supply. Furthermore, the evidence suggests that mortality data actually correlate quite well with the available measures of both morbidity and social deprivation. But without access to comprehensive morbidity data the SMR debate is bound to remain inconclusive. As measures of health need, however, SMRs have the twin merits of being (a) independent of supply, and (b) more direct measures of health state than social indicators.

Health Resources↗

PubMedDate not supplied

[Health resources allocation in Canada provinces: the role of indicators of health needs].

In an attempt to limit their health care expenditures Canadian provinces have strengthened the necessity to allocate health care resources according to their population needs. The difficulties and limitations of the needs-based approach are explored. First, indicators of population needs for health care were introduced into a formula of resource allocation for hospital-based services in England in the late 1970. Secondly, there are broad similarities between both the philosophy and resource allocation strategies of Canada and Britain. Thirdly, the main definition of a needs indicator is to measure the level of equity- or inequity-in the distribution of health care resources between regions. Fourthly, a needs indicator, as least as developed by the Canadian provinces, concerns general and specialized services that should be found in each of their regions. Fifthly, a needs indicator constitutes a tool for the calculation of a capitation rate. Finally, future research should focus on parameters which are not an integral part of the allocation method, but which have a strong impact, in the attainment of regional equity such as administrative decisions that are taken when budgets are to be allocated or reduced between regions.

Canada↗

PubMed2006

Severity of AD/HD symptoms and efficiency of attentional resource allocation.

This study investigated the mechanism that underlies the inefficient allocation of attentional resources in Attention-Deficit/Hyperactivity Disorder (AD/HD). The P300 event-related brain potential (ERP) was elicited from 24 healthy adults using a visual three-stimulus oddball paradigm (standard, 70%; target, 15%; non-target, 15%) and the degree of their AD/HD symptoms was assessed by using AD/HD symptom scales. Target stimulus was a circle and standard stimulus was an "X". Two task conditions were defined according to the non-target stimulus type (typical or novel): a triangle for the typical condition and colored non-repetitive novel stimuli for the novel condition. In both conditions, target and non-target elicited P300s. A ratio of non-target P300 to target P300 amplitude was used to assess the efficiency of attentional resource allocation; low ratio indicates the efficient allocation of attentional resource. The correlation analysis revealed a strong positive correlation between the AD/HD symptom score and the P300 amplitude ratio in the typical condition (r=.80), while only a weak positive correlation was observed in the novel condition (r=.23). The present study found that the commonality of task-relevant and task-irrelevant information, rather than the stimulus novelty of task-irrelevant information, induces the inefficient allocation of attentional resources in AD/HD.

Adult↗

PubMed2004

Resource allocation equity in northeastern Mexico.

Currently, the population health needs are unlimited, but allocation of financial resources is not in accordance with these needs, probably due to the lack of specific information. In this work, we propose a new approach to allocate resources with equity as a tool for decision-making in planning. The grade of equity in resource allocation in decentralized management medical areas (DMMAs (AMGD, for its initials in Spanish)) was determined; these are limited geographical areas of a social security institution in three states of the northeastern region of Mexico. The areas with more health needs in the global index were DMMA no. 12 in Tamaulipas with a Z-score (ZS) of -5; area no. 3 in Coahuila with -4; and area no. 9 in Nuevo Leon, no. 16 and no. 17 in Tamaulipas with -2. Equity was measured according to the degree of concordance between the health needs index and the per capita health expenditure of each area: (r = 0.19, P > 0.05). Low concordance was found between these variables in the studied medical areas.

Health Care Rationing↗

PubMed2003

Allocating resources for health and social care: the significance of rurality.

Whilst an allowance is made for sparsity in the allocation of resources for social care services in England, rurality is not a significant factor in health resource allocation. This lack of consistency in resource allocation criteria has become increasingly visible as health and social services departments are required to work in partnership across a range of areas. Differences in funding mechanisms also raise the question of why it is legitimate to make adjustments for rurality in the distribution of some public services, but not for others. Against this background, the present paper considers the case for a rural premium in health resource allocation which, it proposes, can be made on four grounds. First, there is evidence that the current National Health Service (NHS) formula introduces systematic biases in favour of urban areas in the way in which it expresses 'need' for healthcare. Secondly, the way in which the current system compensates for unavoidable variations in the costs of providing services takes insufficient account of the additional costs associated with rural service provision. Thirdly, with a growing emphasis on the need to attain national quality standards, rural primary care trusts and social services departments can no longer tolerate lower levels of services. Finally, a case for a rural premium can be made on the basis of precedent. England is the only country in the UK that does not make a major adjustment for rurality in its NHS formula. The paper concludes that the English NHS resource allocation system has done little to counter marked service deprivation in rural areas. Given evidence that rural local authorities also spend less on social care services and direct provision, this raises serious questions about the extent to which the needs of vulnerable people in English rural areas are being adequately served.

England↗

PubMed2004

Equity in resource allocation in the Irish health service. A policy Delphi study.

Resource allocation in the Irish health service, based on historical allocations with incremental increases, is widely believed to be inequitable. Using a three-round policy Delphi survey, which seeks to explore both consensus and disagreement surrounding policy issues, the views of 52 senior health service personnel were sought in order to determine ways to improve equity in resource allocation. Panelists provided several reasons why the current method of resource allocation is inequitable and several suggestions for improving equity. The level of consensus on views was determined by calculating the percentage of ratings in each category based on a series of rating scales. The main suggestion centred around the development and implementation of a needs based resource allocation formula. Panelists reached a high consensus in favour of this but only reached a low consensus as to its feasibility. Potential obstacles identified included methodological difficulties, insufficient resources and resistance from potential losers. These findings highlight concerns about the lack of transparency in the resource allocation process and openness to the development of a more equitable needs based resource allocation model, a move which is becoming more common internationally. Feasibility concerns should not preclude an attempt to begin this process.

Delphi Technique↗

PubMedDate not supplied

An analysis of optimal resource allocation for prevention of infection with human immunodeficiency virus (HIV) in injection drug users and non-users.

Millions of dollars are spent annually to prevent infection with human immunodeficiency virus (HIV) without a thorough understanding of the most effective way to allocate these resources. The authors' objective was to determine the allocation of new resources among prevention programs targeted to a population of injection drug users (IDUs) and a population of non-injection drug users (non-IDUs) that would minimize the total number of incident cases of HIV infection over a given time horizon. They developed a dynamic model of HIV transmission in IDUs and non-IDUs and estimated the relationship between prevention program expenditures and reductions in HIV transmission. They evaluated three prevention programs: HIV testing with routine counseling, HIV testing with intensive counseling, and HIV testing and counseling linked to methadone maintenance programs. They modeled a low-risk IDU population (5% HIV prevalence) and a moderate-risk IDU population (10% HIV prevalence). For different available budgets, they determined the allocation of resources among the prevention programs and populations that would minimize the number of new cases of HIV infection over a five-year period, as well as the incremental value of additional prevention funds. The study framework provides a quantitative, systematic approach to funding programs to prevent HIV infection that accounts for HIV transmission dynamics, population size, and the costs and effectiveness of the interventions in reducing HIV transmission. The approach is general and can be used to evaluate a broader group of prevention programs and risk populations. This framework thus could enable policy makers and clinicians to identify a portfolio of programs that provide, collectively, the most benefit for a given budget.

AIDS Serodiagnosis↗

PubMed2003

Decentralization in Zambia: resource allocation and district performance.

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or negative impact on services.

Budgets↗