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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↗
PubMed1996

Patient outcome and intensive care resource allocation using APACHE II.

A prospective study of seventy consecutive admissions to the Medical Intensive Care Unit (MICU) of a local hospital over a five-month period was conducted with the aim of developing objective criteria for critical care resource allocation. Patients gaining admission were subjected to APACHE II scoring and their progress followed till they recovered from their illness or perished. The mean APACHE II score of patients who recovered from their illness or perished were 12.96 and 28.52 respectively (p < 0.001). 91.5% of all patients who recovered had an APACHE II score of below 21 whereas 82.6% of those who died had an APACHE II score of more than 23. Males generally had poorer outcome than females [47% mortality vs 8% (p < 0.001)] although their mean ages were comparable [47.6 years vs 46.6 years respectively (p = 0.85)]. The mean APACHE II scores of male and female patients were significantly different [male = 20.6 vs female = 13.6 (p < 0.005)] and this partly accounted for the poorer outcome of males. The APACHE II score has considerable predictive value on the final outcome of patients admitted to the MICU. When ICU beds are short, the allocation of such beds may be made with consideration of the APACHE II Score which identifies the patient who is most likely to benefit from ICU care.

APACHE↗
PubMed1995

Ethical cautions in the use of outcomes for resource allocation in the managed care environment of mental health.

Increasingly, resources are being allocated through competitive contracting based on outcome data. This context for outcome research renews ethical concern about the nature of outcome data in the field of mental health. The epistemology of mental illness creates special concerns regarding outcome measurement. Ethical cautions specific to six types of outcome measurement are reviewed: utilization, clinician reports, patient reports, objective measures of diagnostic entities, objective measures of functioning and multifactor research. Brief guidelines are offered for addressing ethical cautions. Also discussed are the difficulty in defining good outcomes and a social obligation to future generations that may be better addressed through process measurements.

Contract Services↗
PubMed1994

Health planning and resource allocation in a changing Vietnam.

Vietnam is rapidly changing from a centrally planned to a market economic system. Explores the existing constraints and the degree of flexibility for management in the Government health system. Analyses the potential influence of the recent changes in health sector resource allocation with budgets becoming less under the direct control of the local authority, and based on population rather than the current number of beds. These changes create new possibilities, and responsibilities, for managers actively to manage health services and preventive programmes. Health managers are ill-prepared for this challenge.

Administrative Personnel↗
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↗
PubMed2000

Resource allocation modelling for home-based health and social care services in areas having differential population density levels: a case study in Northern Ireland.

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.

Catchment Area, Health↗
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↗
PubMed1980

The planner as public health resource allocator: post-Proposition 13 county health services in California and the role of the HSAs in budget review and public hearings.

Immediately following adoption of Proposition 13 in California in June of 1978, the state legislature adopted a Bail-Out program which included procedures for monitoring the detrimental effects of disproportionate reductions in public health, inpatient and outpatient county budgets. For a variety of reasons, the methodology and procedures employed failed to reveal the adverse effects of Proposition 13 on health services. This paper deals with the actual and potential role of health systems agencies (HSAs) in monitoring such effects, commenting in public hearings on budget review and, in general, playing a policy analysis role that links local government with the citizenry on the one hand and the state government on the other. In addition to identifying the weakness of the State's monitoring effort in identifying negative effects in program analysis and staffing reductions, the findings point out the limited role of HSAs. Specific recommendations are offered for improvement of HSA involvement in future resource allocation planning in California and the United States as a whole.

California↗
PubMed1998

Delimiting 'rural': implications of an agreed 'rurality' index for healthcare planning and resource allocation.

Rural and remote Australia is characterised by considerable geographical and social diversity. There is no 'natural' classification of what constitutes 'rural' or 'remote', and precise definition of what is meant by the term 'rural' has proved to be an elusive goal. Nonetheless, it is recognised that the differentiation of rural areas has important implications for healthcare planning and the research that underpins it. Whether it be the development of resource allocation formulae that determine the provision, location and type of rural health services, measuring service utilisation rates as an indicator of need for services or health outcome measures, the way in which populations and communities are delimited as urban, rural and remote will always influence and sometimes may even determine the assessment. The time is ripe for the development of an agreed classification for the investigation of rural health issues.

Australia↗
PubMed1994

Medical resource allocation: rationing and ethical considerations--Part I.

The United States' system of high-quality but expensive and poorly distributed medical care is in trouble. Dramatic advances in medical knowledge and procedures, combined with soaring demands created by growing public awareness, the cost of private hospital and medical insurance, and Medicare and Medicaid, are burdening the medical care delivery systems. The costs of medical care have reached levels that can no longer be sustained. Government officials, insurance planners, labor leaders responsible for union health care benefits, and ordinary citizens are questioning whether it is acceptable to limit health care based on economic considerations. If health care is deemed a social good, the method of allocation must be addressed. Unless society decides that other priorities of the infrastructure are to be subjugated to health service delivery, difficult decisions will be forced upon us, consciously or by default. The discussion in this two-part article explores the ethical considerations of the more formalized approaches to resource allocation that presently exist in our society.

Aged↗
PubMed1980

A framework for optimizing resource allocation for health education programs.

Health education programs conventionally are implemented in four sites: school, clinical, occupational, and community settings. One problem encountered by health education specialists, community health planners, and policy makers, is ascertaining the optimal allocation of health education resources to these four settings. This paper proposes a framework to assist in making this decision. The framework incorporates considerations of the target group, the health problem, the desired health behaviors, and administrative aspects of the program, which are broken down into 26 different "criteria", (e.g., age of target group, stage of disease intervention). Each of the 26 criteria has its respective "dimensions" (e.g., age of target group: preschool children, school children, and adults), and each dimension in turn suggests the optimal health education setting(s). An improved understanding of the advantages and disadvantages of implementing health education programs in the different sites will facilitate better coordination between practitioners in school, clinical, occupational, and community settings.

Child, Preschool↗
PubMed1994

Allocating resources for health and social care in England.

The fair allocation of resources for health and social care in relation to the needs of the population in different parts of the United Kingdom has become particularly important since the implementation of the new arrangements for community care in April 1993. These depend on close collaboration between health authorities and local authority social services departments. Yet funding reaches these authorities by different means and according to different criteria. Most health authority funds come through a weighted capitation formula that overemphasises the effects of age, while family health services funding is largely not cash limited and hence demand led. Funds to local authorities for community care are being transferred from the social security budget but on a basis that partly reflects past provision of residential and nursing home care. None of these mechanisms responds to underlying needs that give rise to demands on the health and social care system as a whole, and none makes any attempt to compensate for defects in the others. The solution includes better research and a unified weighted capitation system for all sources of funding.

Capital Financing↗
PubMed1994

A dual-task analysis of resource allocation in dysthymia and anhedonia.

Research has shown dysthymic individuals to be hyporesponsive at various stages of information processing, yet it is not clear whether dysthymics are deficient in the amount of available attentional resources for information processing or, instead, in the allocation of those resources. To distinguish between these possibilities, the authors compared dysthymics to anhedonic and normal control Ss during the performance of memory tasks, under conditions of varying task priority and difficulty. Although there were no performance differences, dysthymics and anhedonics exhibited a consistently smaller P300 component of the event-related potential. Furthermore, P300 results indicated that dysthymics and anhedonics responded differently from controls to variations in task demands. Thus, although evidence was obtained for group differences in both resource capacity and resource allocation strategy, the overall pattern of results is interpreted as favoring the latter.

Attention↗
PubMed1991

Allocating resources to health care: is the QALY (Quality Adjusted Life Year) a technical solution to a political problem?

The allocation of health care resources has always been and will remain a contentious issue. Classically, the arguments have been posed in terms of the "need" for health care and/or the "right" to treatment. More recently, there have been attempts to shape the debate in consequentialist terms, by introducing a composite outcome measure. In the United Kingdom, the QALY (Quality Adjusted Life Year) has been promoted enthusiastically. But, like many other such proposals, it is a dodo, and one that is potentially politically dangerous.

Decision Making↗
PubMed1993

QALYs for resource allocation: probably not and certainly not now.

Quality-adjusted life years (QALYs) have the attractive characteristic of combining morbidity and mortality into a single index which purports to measure the outcomes of health interventions. Their primary aim, when combined with cost, is to permit comparisons across candidate spending programs and thereby promote economic efficiency in the use of rationed funds. QALYs, in fact, comprise a family of measures with major differences in approach and many variations in construction, process and methods of measurement. A necessary unifying characteristic is the ethical assumption of utilitarianism. The paper examines the state of the art in the development of QALY measures. It concludes that they fall far short of requirements for their advocated use in resource allocation decisions. Furthermore, their demands on measurement for this purpose are such that it is unlikely that methodological problems can be solved.

Australia↗
PubMed1977

Mortality, morbidity, and resource allocation.

The correlation between age and sex standardised mortality-rates, and morbidity-rates from the General Household Survey (G.H.S.) similarly standarised, were examined for the 10 standard statistical regions for 1972 and 1973 combined. The correlations between mortality and acute sickness and between mortality and bed sickness were not significant. A significant correlation was found between mortality and chronic sickness, but not between mortality and work or school absence due to illness or injury in males. It is concluded that, on present evidence, there is some doubt whether mortality can be considered to be a valid indicator of morbidity in a population. Serious consideration should therefore be given to the removal of standarised mortality ratios (S.M.R.S.) from the formula for the distribution of revenue as recommended by the Resource Allocation Working Party (RAWP).

Absenteeism↗