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At least 19 recordsLinked to original sources
PubMed1998

Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario.

Maintaining or improving the welfare of the population is a complex issue involving individual and collective actions and institutions. Despite questions regarding the relevance of health care systems to these aims, they remain vital policy and treatment arenas with respect to curative and preventative regimes. As a component of social welfare, health care resources should be distributed equitably, according to need for health care. This paper evaluates alternative indicators of health status within Ontario against self-reported health as a means of allocating health care resources. Proxies of need for health care include standardized mortality ratios (based on the population aged 0-64) and a socioeconomic based indicator. Mortality indicators are found to be more closely correlated with self-reported health status than the socioeconomic indicator, suggesting that mortality is better able to reflect variations in health status and health care needs.

Adolescent↗
PubMed2004

An integrated approach to resource allocation.

Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help depoliticise rationing decisions and command greater public acceptance.

Cost-Benefit Analysis↗
PubMed1994

Is there a role for physicians in health and medical resource allocation?

Resource allocation decisions affecting health and medical care must be based on sound ethical and economic analysis. Should physicians be involved in these discussions? Some posit that physicians must be patient-advocates, and thus, cannot participate. Others argue that physicians have an integral role to play in shaping the health care system. This article proposes a role for physicians at all levels of resource allocation discussions.

Canada↗
PubMed1994

Hospital resource allocation.

Good resource allocation is essential to effective hospital cost management. Yet current allocation methods are weak, and the damage done by bad allocations cannot be undone with utilization fine-tuning. The three traditional methods are resource-allocation-by-momentum (RAM); resource-allocation-by-physician (RAP); and resource-allocation-to-survive (RAS). As hospitals change, a new allocation method is needed: resource-allocation-in-response-to-need (RARN). To determine appropriate allocations, RARN analyzes each activity based upon community need, hospital response, and economics. RARN balances cost management emphasis of doing things right (utilization) with doing the right things (allocation).

Cost Control↗
PubMed2000

Regional differences in health care delivery: implications for a national resource allocation formula.

In several countries formulae for allocating resources to regions are derived using national average relationships between population characteristics and health service use. However, there may be significant regional heterogeneity in health care delivery which, has two main implications for a national resource allocation formula. First, it offers alternative ways of measuring the relative needs of different population groups. Since the primary focus of research and policy is on the difficulty of targeting resources at high-need populations, it is proposed that progressivity in the delivery of health care could be seen as a frontier problem analogous to efficiency. The effects of using the slope parameters from the most progressive region are simulated. Second, regional heterogeneity may thwart the objective of the formula of securing equitable use of resources by different population groups. An adjustment mechanism is developed to illustrate the trade-off between the levels of geographical and vertical equity achieved. A locus of equity possibilities for acute care in Scotland is derived. Traditional formulae represent a corner solution indicating extreme relative aversion to geographical inequity. Because regional variation in need dominates regional variation in progressivity in Scotland, high-need rather than progressive regions gain from the pursuit of vertical equity.

Acute Disease↗
PubMed1991

The development of distributive justice orientations: contextual influences on children's resource allocations.

Previous research on the development of distributive justice decisions, by centering largely on situations in which rewards for work productivity are to be allocated, has shed little light on the child's developing ability to select the justice norm most appropriate to the situation. Children 5, 9, and 13 years of age were asked to allocate resources and judge the fairness of alternative decision rules in situations to which either equity, equality, or need norms were especially applicable. As predicted, young children were insensitive to contextual information, generally preferring to allocate resources equally, whereas older children tailored their decisions appropriately to the situation. The fact that developmental trends differed from situation to situation points to the importance of adopting a contextual perspective on the development of distributive justice orientations.

Adolescent↗
PubMed1996

The selection of needs indicators for regional resource allocation in the fields of health and social services in Québec.

In Québec, recent political statements have strengthened the necessity to allocate resources according to regional population needs. A regional-provincial working group was set up to propose needs indicators in 8 different fields-or client-oriented programs-which subdivide the entire spectrum of health and social services in Québec. These programs include physical health, mental health, public health, functionally impaired elderly people, physical deficiency, intellectual deficiency, alcoholism and drug abuse and problems (abuse, neglect, delinquency) among young people and their families. The following paper summarizes the main proposals of the working group. Some comments are made on the definition of client-oriented programs, basic concepts, research questions and methodological approaches. Concrete examples are given in order to illustrate the type of data and methods used. Furthermore, the indicators selected for resource allocation (in each of the 8 client-oriented programs) are presented on a regional basis (n = 18) and introduced in a principal component analysis. Their variations are discussed and recommendations to facilitate their use and promote their development are made. Finally, the actual utilization of these indicators is reported.

Adolescent↗
PubMedDate not supplied

Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network.

AIMS: There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. METHODS: Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. RESULTS: Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no 'one size fits all solution. CONCLUSIONS: There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems.

Capital Financing↗
PubMed2006

Adaptive task prioritization in aging: selective resource allocation to postural control is preserved in Alzheimer disease.

OBJECTIVE: With age, the performance of multiple tasks decreases, a pattern exaggerated in Alzheimer disease (AD). At the same time, recent research, based on adaptive theories of healthy aging, indicates a preference of older adults to allocate resources toward tasks of higher immediate value (e.g., postural control). This study investigated whether such models also hold for pathologic cognitive aging. METHOD: Using a dual-task paradigm, the authors combined a working memory with a postural control task under easy and difficult conditions in patients with AD, older adults, older adults low on performance on a cognitive marker test, and young adults (N = 40). Participants repeatedly performed a cognitive and a postural control task both simultaneously and in isolation over the course of eight sessions. RESULTS: Consistent with earlier studies on divided attention in age and AD, the authors found large dual-task performance decrements with age and more so in AD. When not challenged, patients with AD showed large performance decrements under dual-task conditions in both postural control and working memory. With increasing difficulty in the postural control task, however, older adults, and more so patients with AD, maintained a high level of functioning in postural control, as compared with working memory. CONCLUSION: The findings indicate that the theory of selective optimization with compensation extends to pathologic aging and have broad implications for models of dual-task performance and executive control in aging and AD.

Adult↗
PubMed1999

Balancing efficiency and need in allocating resources to the care of persons with serious mental illness.

The care of patients with serious mental illness, for whom a cure is unlikely and costs are high, is difficult to justify using ordinary standards of efficient resource allocation. The author examines the difficulties of using conventional utilitarian, cost-benefit, moral, and political arguments to justify allocation of resources to the care of persons with serious mental illness and offers an alternative approach to this problem based on the goals of medicine. Although care for persons with serious mental illness may not meet the usual standards of efficient health care spending, their treatment is justified by central and long-standing goals of medicine such as relief of pain and suffering and care of those who cannot be cured. This approach suggests that the idea of efficiency in health care spending should be adapted to the goals of medicine rather than making those goals adapt to the idea of efficiency.

Chronic Disease↗
PubMed2000

A review of alternative approaches to healthcare resource allocation.

The resources available for healthcare are limited compared with demand, if not need, and all healthcare systems, regardless of their financing and organisation, employ mechanisms to ration or prioritise finite healthcare resources. This paper reviews alternative approaches that can be used to allocate healthcare resources. It discusses the problems encountered when allocating healthcare resources according to free market principles. It then proceeds to discuss the advantages and disadvantages of alternative resource allocation approaches that can be applied to public health systems. These include: (i) approaches based on the concept of meeting the needs of the population to maximising its capacity to benefit from interventions; (ii) economic approaches that identify the most efficient allocation of resources with the view of maximising health benefits or other measures of social welfare; (iii) approaches that seek to ration healthcare by age; and (iv) approaches that resolve resource allocation disputes through debate and bargaining. At present, there appears to be no consensus about the relative importance of the potentially conflicting principles that can be used to guide resource allocation decisions. It is concluded that whatever shape tomorrow's health service takes, the requirement to make equitable and efficient use of finite healthcare resources will remain.

Health Care Rationing↗
PubMed1991

A methodology for resource allocation in health care for South Africa. Part IV. Application of South African Health Resource Allocation formula.

The primary concern of this concluding article in a series is the application of the South African Health Resource Allocation (SAHRA) formula proposed in the previous article (SAMJ 1990; 77: 456-459). Target allocations based on this formula are compared with current budgets to estimate the extent of geographical maldistribution of health care resources. Under the present health service structure, the direction of redistribution of these resources should be from the provinces to 'homelands'. A number of refinements to the crude formula, such as the introduction of a more rational regionalisation policy and accounting for the teaching commitments of academic hospitals, are considered and their effects illustrated. Despite data deficiencies and the wide range of possible technical modifications to SAHRA, the concept of basing resource allocation decisions on an internationally applied formula is worthy of public debate.

Education, Medical↗
PubMedDate not supplied

Pressure sores and pressure sore prevention in a rehabilitation setting: building information for improving outcomes and allocating resources.

Quantifiable information regarding pressure sore prevention and management is a prerequisite for program development, outcome evaluation, and resource allocation. In this study, all patients admitted to an acute rehabilitation setting (N = 446) during a 2-month period were assessed for the presence of a pressure sore, the risk for developing a pressure sore, the rate of agreement between "objective" (Braden scale) and "subjective" (standard nursing admission data) measures of risk and outcome, and the status of pressure sores at discharge. This article provides the details of the project and implications for rehabilitation nursing practice.

Adolescent↗
PubMed1989

Allocating resources to health care: RAWP (Resources Allocaton Working Party) is dead--long live RAWP.

In England, according to the White Paper, "Working for Patients' the RAWP formula (Resources Allocation Working Party) is to be abandoned. Instead, according to the Working Papers, allocations are to be based on populations weighted for their health and age distributions. In the distributions from the centre to the Regions, SMRs (Standardized Mortality Ratios) are to be retained as a proxy for morbidity albeit with a different weight. This is based, partly, on the analysis carried out by Coopers and Lybrand for the RAWP Review which is shown to be inadequate both conceptually and empirically. The criteria to be used for distributing to Districts and General Practitioners are unclear but "allowance will be made for local and social factors' which suggests that some deprivation index will be incorporated into the process. The most likely choice is the Jarman index and this is shown to be equally inappropriate. The criteria used in allocation, as well as being conceptually coherent and empirically practicable, should be clear and comprehensible to all concerned. The proposals in the White Paper fulfil none of these criteria.

Health Services Needs and Demand↗
PubMed1996

Making choices in hospital resources allocation. The use of an assessment tool to decide which new projects are financed.

We designed a scoring system to rank acute care hospital projects and allocate resources between them. The evaluation tool assessed projects on an ordinal scale; the criteria scored were medical interest, feasibility, interest for teaching and research, and compatibility with the hospital's strategy. Clinical and technical projects were ranked separately. In 1994, 25 new projects, representing a total cost of $1.4 million, were reviewed by two independent reviewers. The scores ranged from 30 to 18 over 36. Projects presented by clinical departments scored higher than projects presented by medicotechnical departments.

Budgets↗
PubMed1993

Resource allocations to the aged according to greatest social need.

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their every-day lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (magnitude of beta i/sigma magnitude of beta i) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.

Aged↗
PubMed1986

Ethics and resource allocation: an economist's view.

This paper debates some of the issues involved in attempting to apply economic analysis to the health care sector when medical ethics plays such an important part in determining the allocation of resources in that sector. Two distinct ethical positions are highlighted as being fundamental to the understanding of resource allocation in this sector -- deontological and utilitarian theories of ethics. It is argued that medical ethics are often narrowly conceived in that there is a tendency for the individual, rather than society at large, to form the focal point of the production of the service "health care'. Thus medical ethics have been dominated by individualistic ethical coded which do not fully consider questions relating to resource allocation at a social level. It is further argued that the structure of the health care sector augments these "individualistic' ethics. It is also suggested that different actors in the health care sector address questions of resource allocation with respect to different time periods, and that this serves to further enhance the influence of "individualistic' ethical codes in this sector.

Cost-Benefit Analysis↗