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Cost containment and access to appropriate care are the two most frequently discussed issues in contemporary health policy. Conceiving of the health services available in specific regions as "packages" of diverse items, the authors of this article consider the economic trade-offs among the various resources needed for appropriate care. In the discussion that follows, we examine the trade-offs between two divergent offering of the health care system: high technology medicine and support services. Specifically, we examine several strategies designed to achieve an optimal mix of investments in CT scanners and transportation resources in the South Chicago region. Using linear programming as a method for examining these options, the authors found that 1) the proper location of CT scanners is as important for cost containment as optimal number, and 2) excess capacity in the utilization of a single resource--CT scanners--need not imply inefficiency in the overall delivery of the service. These findings help demonstrate the importance of viewing health care as a package of interrelated services, both for achieving cost containment and for providing access to appropriate care.
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In recent years, three thorough analyses have documented the present status of the availability of neurologists and estimated future needs and availability. The productivity of ongoing training programs would appear to be able to meet the minimal needs for neurologic services by 1985. Pending federal legislation may regulate the total number of residencies available in the future. The American Academy of Neurology has a role in maintaining a data base and analyzing the issues of quality maintenance, utilization of resources, and distribution of personnel.
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The methods and principles of allocating centrally provided health care resources to regions and areas are reviewed using the report of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) and the consultative document (Department of Health and Social Security, 1976a) as a basis. A range of practical problems arising from these papers (especially the report of the RAWP) is described and traced to the terms of reference. It is concluded that the RAWP misinterpreted aspects of social and administrative reality, and it failed to recognise clearly that the several principles on which it had to work conflicted with each other and demanded decisions of priority. The consequential errors led to (a) an injudicious imposition of 'objectivity' at all levels of allocation, (b) an unjustified insistence that the same method be used at each administrative level in an additive and transitive manner, (c) the exclusion of general practitioner services from their considerations, (d) a failure to delineate those decisions which are in fact political decisions, thus to concatenate them, inappropriately, with technical and professional issues. The main requirement in a revised system is for a mechanism which allocates different priorities to different principles at each appropriate administrative and distributive level, and adapts the working methods of each tier to meet separately defined objectives.
The assumption that a centrally planned national health care system could match resources to needs has proved to be a chimera. Shortages are inherent in any system that is more or less "free at the point of access" while it still permits unlimited scientific innovation for its patients. Rationing by science is as unsatisfactory as is political or economic rationing: equality in health care cannot be in balance with uncontrolled technological innovation.
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An innovative mental health primary and secondary prevention program employing mass media was conducted in the Louisville metropolitan area. For 60 weeks during public service announcement time slots, 21 educational mental health and mental retardation messages were aired on local major radio and television stations. Three project goals were established: (a) improved mental health attitudes; (b) increased awareness of community mental health resources; and (c) increased utilization of community mental health resources. Systematic evaluation, based on data from client-initiated telephone contacts and surveys of the community, indicated that the project appeared to be successful in increasing awareness and utilization of community mental health resources. Positive change was indicated, overall, for attitudes related to cognitive structuring of problem situations. Attitudes related to behavioral resolution of problem situations appeared to be generally uninfluenced. Implications and future directions for the utilization of mass media in community mental health are discussed.
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Causal modeling (path analysis) was applied to data from the 39 mental health catchment areas of Massachusetts to analyze the effects of sociocultural and health-resource variables on long-term-care utilization. The variables chosen explained 53 percent of the variance of long-term-care use by persons 60 and older: 41 percent was explained by the sociocultural variables and 12 percent by the health-resource variables. With data adjusted for age, the major determinant of long-term-care use was ethnicity: less long-term care was used in areas with more persons who were foreign-born or had a foreign-born parent. The effects of other health resources (supply of primary care physicians and use of mental and general (short-term) hospitals) were small and negative.
BACKGROUND: Complex digital interventions that integrate electronic patient-reported outcome measures (ePROM) into clinical practice in cancer have the potential to improve quality of life, increase survival, and reduce health resource use and costs. Such systems can help patients with cancer self-manage chemotherapy symptoms, reduce clinicians' workloads through automated decision support, and resolve problems earlier. However, more research on the cost-effectiveness of ePROM monitoring is needed. OBJECTIVE: This paper comprises two complementary components: (1) a systematic literature review summarizing and evaluating the quantitative and qualitative evidence related to the cost-effectiveness of ePROM monitoring and (2) a health economic model parameter extraction. We also conducted supplementary targeted searches and scoping to provide context to our findings. METHODS: We searched Ovid (including MEDLINE and Embase), Scopus, and the International Health Technology Assessment Database for original English-language papers published on or before March 2025 using search strings that combined terms related to ePROMs, health economics, and cancer/oncology. We included papers reporting health economic-related outcomes for ePROM interventions designed for adult cancer populations and excluded screening tools and conference abstracts. RESULTS: We included 34 publications from 27 unique studies and identified and analyzed 26 ePROM-integrated interventions within these. Most (23/26) of the included interventions explicitly described some form of alert handling and automated decision support based on remote ePROM monitoring. Of the 34 publications, 5 presented full cost-effectiveness analysis results, of which 3 were highly uncertain and lacked clear differences in costs and health outcomes between ePROMs and standard care; conversely, 2 presented strong evidence of cost-effectiveness due to quality-of-life improvements, reduced hospitalizations, and potentially more autonomy in health-related travel (eg, ePROM-monitored patients can drive or walk to the hospital instead of using taxis or ambulances). A further 5 publications reported partial health economic results (eg, cost-consequence and budget impact), of which 1 detected no difference in strategies; in contrast, 4 reported lower health resource use and costs of ePROMs, mainly due to hospitalization reductions. Overall, 12 of the 27 studies included a qualitative component but mostly focused on user experience and design-related themes; only 2 of these addressed economic-specific themes (eg, changes in workflow and resource use due to ePROM implementation and integration), indicating some potential for time saving due to ePROM monitoring. CONCLUSIONS: Some ePROM-integrated interventions demonstrated cost-effectiveness in cancer care, but the evidence base remains limited. Where evidence does exist, cost-effectiveness appears driven by reduced hospitalization and improved quality of life. Qualitative research within the included studies rarely addressed economic questions. We provide a detailed parameter extraction for use in future economic modeling and recommend research priorities, including quantitative mapping of ePROM symptom data onto health resource use patterns, and qualitative work exploring how ePROM implementation affects clinical workloads and patient-perspective costs.