Search PubMed⌕ Search

Biomedical subjects

G Mooney

Publications and source records attributed to G Mooney.

At least 37 records · Page 2Linked to original sources
PubMed1998

Beyond health outcomes: the benefits of health care.

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizens qua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens' interests in health care will be restricted to health.

Australia↗
PubMed1998

Burden of illness estimates for priority setting: a debate revisited.

This paper returns to the debate in this journal about a decade ago on the value of cost of illness (COI) and burden of illness (BOI) estimates in priority setting. Concern is expressed that there has been a resurgence of interest in calculating and using BOI estimates in such priority setting. It is especially concerning that this interest seems to have support from both the World Bank and the World Health Organisation (WHO) (although perhaps less so recently from the latter). It is argued that in terms of priorities for health services, BOI calculations are irrelevant except possibly in the context of some (less than ideal) concept of need in support of equity. If the need basis for equity is set in terms of 'capacity to benefit', then BOI calculations become even less relevant. There is an argument for some research funding being prioritised in terms of BOI but only when it is genuinely the case that there is total ignorance, beyond the size of the problem, about a particular policy or disease area. Such a level of ignorance will happen very seldom and then some fairly approximate estimates of BOI will suffice. It is better to concentrate in priority setting on estimating the costs and benefits of marginal changes than devoting scarce analytical resources to superfluous estimates of BOI.

Australia↗
PubMed1998

"Communitarian claims" as an ethical basis for allocating health care resources.

This paper presents the case for re-examining the most commonly adopted basis of resource allocation in health care, i.e. need. The key problems identified with most needs approaches are (a) defining its precise meaning, (b) that the community is seldom consulted as to first what constitute needs for health care or second what relative weights are to be attached to health gains aimed at addressing different needs and (c) more generally, proceeding without knowing what the community wants the objectives of health care to be. It is suggested that John Broome's notion of "claims", especially what this paper calls "communitarian claims", may be helpful in providing a better basis for allocating health care resources. Such "communitarian claims" allow inter alia for the community to be involved in setting the social choice rules with respect to the governance of health care and for determining what it is that it (the community) wants from its health service. The links to rights are also identified and the advantages of communitarian claims over both a simple concept of need and rights are set out, without arguing that either needs (or rights) ought necessarily to be abandoned as bases for resource allocation in health care.

Australia↗
PubMed1997

Vertical equity: weighting outcomes? or establishing procedures?

Considerations of equity in the health policy literature have in the main focussed on horizontal equity (the equal treatment of equals) and as a consequence have tended to overlook vertical equity (the unequal, but equitable, treatment of unequals). There is evidence from earlier, if preliminary, work carried out by the authors and a colleague that health care decision makers may well want to embrace concerns for vertical equity in the allocation of health service resources. This paper examines some possibilities for incorporating vertical equity into health care policy through distributive and/or procedural justice. While no firm solutions are offered, it is suggested that the idea of fitting John Broome's notion of 'claims' within a communitarian framework holds promise.

Australia↗
PubMed1997

Professionalization in public health and the measurement of sanitary progress in nineteenth-century England and Wales.

During the course of the nineteenth century, the Registrar-General's Office in England and Wales used crude mortality rates as a demographic barometer of the environmental conditions of towns and cities. The local authorities in places with comparatively high rates were exhorted to improve them through more and better public health reforms. This technique of public coercion was often criticized, especially by a selection of Medical Officers of Health, who argued that crude death rates were an inaccurate measure of changing mortality levels and thus the success of preventive medicine. The debate over sanitary progress created no little tension between staff at the General Register Office and the Medical Officers, as well as between the Medical Officers themselves, at a time when public health doctors were seeking to properly establish themselves as a legitimate, professionalized branch within medicine. Despite this, the collection and dissemination of local mortality statistics became an indispensable component for the nineteenth century campaign to improve the nation's health.

History, 19th Century↗
PubMed1996

Has access to hospital improved for Aborigines in the northern territory?

One of the stated aims of Australia's health care system is to achieve equity of access to health care according to need for all Australians, with the ultimate goal of moving toward statistical equality of good health for all. This paper examines how, using routinely collected population health data, we might answer the question of whether access to hospital care for Aborigines in the Northern Territory (NT) improved in relation to access for non-Aborigines during the period 1979 to 1988. Some of the advantages and shortfalls of this approach are discussed and an 'index of access' is postulated. This index is shown to be moving towards 1 during the period, suggesting that access to hospitals has improved for Aborigines compared with non-Aborigines, but that a substantial shortfall still exists. While this index can be useful for measuring progress toward achieving the horizontal equity of equal access for equal need, the more difficult task of defining and measuring progress toward vertical equity goals with respect to the persistent and gross inequalities in health status between Aboriginal and non-Aboriginal Australians deserves priority.

Adult↗
PubMed1995

Examining preferences for allocating health care gains.

This study is part of a programme to elicit and examine community preferences for health care in different contexts. Data were obtained from a group of predominantly Australian health care decision-makers. A short questionnaire contained six valuation questions and four demographic questions. The six valuation questions posed choices where equal health gains were to be allocated to different population groups based upon: age; sex; current health; socio-economic status; across time; and across different numbers of individuals. The results provide some evidence that respondents were prepared to discriminate between health gains derived in different contexts especially where health gains were to be allocated between groups of different health status and over time. Further research is planned and the possible implications for health policy, and in particular for resource allocation in health care, are briefly discussed.

Age Factors↗
PubMed1995

Public health and economics in tandem: programme budgeting, marginal analysis and priority setting in practice.

In the wake of the reforms of the UK National Health Service there has been increased interest in 'getting it right' with respect to priority setting in health care. This article examines the way in which programme budgeting and marginal analysis (PBMA) were introduced into North Mersey. It provides a very practical introduction to the topic and indicates the actual processes that were gone through. It is suggested that, in terms of getting participants in the PBMA exercise to think through what programmes comprise, what they cost, what they are trying to achieve and to focus on relevant possible changes, there was considerable merit in the approach. However there are problems, particularly at the level of determining the costs of different programmes.

Budgets↗