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PubMed2004

Women, men and public health-how the choice of normative theory affects resource allocation.

Women live longer than men in almost all countries, but men are more privileged in terms of power, influence, resources and probably morbidity. This investigation aims at illustrating how the choice of normative framework affects judgements about the fairness in these sex differences, and about desired societal change. The selected theories are welfare economics, health sector extra-welfarism, justice as fairness and feminist justice. By means of five Swedish proposals aiming at improving the population's health or "sex equity", facts and values are applied to resource allocation. Although we do not claim a specific ethical foundation, it seems to us that the feminist criterion has great potential in public health policy. The overall conclusion is that the normative framework must be explicitly discussed and stated in issues of women's and men's health.

Ethical Theory↗
PubMedDate not supplied

Epidemiology and health service resource allocation policy for alcohol, drug abuse, and mental disorders.

Data from the NIMH Epidemiologic Catchment Area (ECA) Study in Baltimore, Md., are used to illustrate the association between alcohol, drug abuse, and mental disorder diagnoses with health service use. A probability sample of 3,481 adult (age 18 and over) residents of a geographically defined Baltimore City population of 175,000 was found to have a 23.4 per 100 population, 6-month prevalence of 13 specific alcohol, drug, and mental disorders. Of this population, 7.1 percent sought outpatient mental health treatment from both general medical physicians and mental health specialists in a 6-month period. The presence of a mental disorder diagnosis increased the average number of visits to all health providers from 1.91 to 4.06 during the same 6-month period. Although the presence of a mental disorder diagnosis clearly increased the probability of using both general medical and mental health services, only 15.6 percent of the persons with a mental disorder sought any mental health treatment during this 6-month timeframe--leaving 84 percent of those with mental disorders not seeking any outpatient treatment during the same period. The addition of a measure of high symptomatology (a score of 4 or more on the General Health Questionnaire) increased the percentage of persons with mental disorder using services to 30.5 percent. When a measure of disability was added to the diagnosis and the high symptom level score, 54.7 percent of the population could be predicted to use some mental health service. These data demonstrate the necessity of having additional patient assessment measures with a diagnosis to predict probable service use. However, even in the most comprehensive multidimensional model, more research is required to explore the phenomena of presumed unmet need--the 45 percent of those with a diagnosis, disability, and high symptoms who do not use services. Hence, epidemiologists who wish to participate in setting policy for resource allocation must join with their colleagues in economics, sociology, and health services research to identify all factors in addition to disease states that either predispose population groups to use services or represent additional resource allocation needs.

Adult↗
PubMedDate not supplied

Food resource allocation patterns in lactating females in a long-term selection experiment for litter size in mice.

Resource allocation patterns, as quantified by residual food intake (RFI), and the consequences for offspring development were investigated during lactation in 96 females of a mouse line selected for 104 generations for high litter size at birth (S-line) and in 87 females of a non-selected control line (C-line). Litters of 45 C-line dams (Cs) and 48 S-line dams (Ss) were standardised (s) at birth; other dams (ns) supported total number of pups born (Cns and Sns, respectively). RFI during lactation was significantly lower in Sns-dams than in C-line dams and Sns-dams. After weaning Sns-dams seemed to be able to restore the negative resource situation. Sns-pups were about 25% less mature than Cns-pups at all times. Maturity was similar for Cs- and Ss-pups from 2 d in lactation on, and about 18% and 53% higher than Cns- and Sns-pups. The pre-weaning mortality rate was significantly higher in Sns-litters (35.6 +/-2.76) than in Cns-litters (4.95 +/-2.23). The results suggest that S-line dams allocated considerably more resources to maintenance of offspring than C-line dams. This was insufficient to provide the offspring with an adequate amount of resources, resulting in reduced pup development and increased pre-weaning mortality rates.

Animals↗
PubMed1980

Mortality, morbidity, resource allocation, and planning: a consideration of disease classification.

The report of the Resource Allocation Working Party recommended that revenue allocations to health authorities should be based, in part, on national patterns of bed usage and local standardised mortality ratios for conditions aggregated according to the chapters of the International Classification of Diseases (ICD). Similar criteria are now being considered for planning purposes by regions. The extent to which diseases which commonly result in the use of hospital care are also common causes of deaths within their ICD chapter was studied. National utilisation figures show that most beds in ophthalmology, ear, nose, and throat surgery, gynaecology, and consultant dentistry, and an estimated one-third or more of the beds used in general surgery, neurosurgery, and plastic surgery, are used for the treatment of conditions which are uncommon causes of death, both in absolute terms and relative to their ICD chapters. It seems unlikely that the requirements for care of patients with these diseases can be measured simply, either by all-causes mortality statistics, or by the use of mortality statistics ascribed to the ICD chapter which such diseases share with other, more common, causes of death. Consideration needs to be given to the diseases treated by each specialty in deciding whether and how to apply mortality statistics in planning for and funding the specialty.

Bed Occupancy↗
PubMed2004

Health care resource allocation: is the threshold rule good enough?

We review the foundations of resource allocation rules based on cost-effectiveness information. Comprehensive approaches, where a total budget is allocated in one go, require estimation of the costs and effects of all available health care programmes, which is unlikely to be practical. A common alternative is to assess individual programmes against a cost-effectiveness threshold. This has been shown to be efficient if the threshold is well calibrated and all programmes can be wholly or partially implemented with constant returns to scale. We discuss the feasibility of these assumptions, and the effects of relaxing them, concluding that programme indivisibility is unlikely to be a serious problem at a national level, but that miscalibration of the threshold and non-constant returns to scale might be. A rule that avoids these difficulties has been proposed previously: a new programme should only be implemented if it can be funded by cancelling another less effective programme. This could never reduce efficiency, unlike the threshold rule, though we show that it might sometimes fail to recommend an efficiency-improving change. We suggest a refinement of this reallocation rule based on explicit estimation of the costs and effects of partial implementation of the programmes under review. Research is required to assess the practicality of this option.

Cost-Benefit Analysis↗
PubMed2005

[Factors and indicators which should be considered in calculating human resources allocation criteria of the centers of disease prevention and control in China].

OBJECTIVE: To develop a series of factors and indicators which should be considered in calculating human resources allocation criteria of the centers of disease prevention and control in China. METHODS: Based on the measurement methodology on CDCs' human resources rational allocation, which has developed by the research team, the paper makes the method of experts' consultation and the datum on whether 168 simple CDCs agreed with these influencing factors and indicators. RESULTS: The paper develops 11 factors and 23 indicators, and finds these factors and indicators have a high agreement in simple CDCs. CONCLUSION: These factors and indicators are scientific, acceptable and reasonable.

China↗
PubMed2005

Modeling change in a health system: implications on patient flows and resource allocations.

This work is motivated by the recent changes in the health system in Turkey, which is a consolidation of health insurance funds, and its implications on the resource allocations and the flow of patients in the system. Our aim is to provide a model to find the best reallocation of resources between the hospitals and the best patient-hospital match to minimize the costs.

Delivery of Health Care↗
PubMed2002

Resource allocation decisions in Canada's health care system: can these decisions be challenged in a court of law.

This paper explores how the Canadian courts have responded to resource allocation decisions that have impacted on patients. While there have been few Canadian cases, those that exist fall into two categories. In the first part of the paper, we discuss recent cases that fall into the category of traditional negligence cases where a patient has been harmed and is seeking redress from the providers of care. What is emerging is that individual defendants, either physicians or institutions, are raising economic factors in their defence. The issue, we examine in this context is whether economic arguments can be successful in justifying the level of care that was provided and we conclude that, to date, courts have not been receptive to these arguments. The second part of the paper discusses those cases where patients have used legal arguments to try and change a governmental/policy decision, or to seek redress from harm caused by such a decision that has affected their access to care. In this context, patients have used principles of administrative law, constitutional law and tort law with varied degrees of success. We provide an analysis of these cases and conclude that it is difficult for patients to succeed when challenging allocation decisions at the policy level.

Canada↗
PubMed2006

Resource allocation for community-based therapy.

PURPOSE: Adequate and equitable resourcing of services for children with disabilities and their families is a challenge that is faced by agencies as the growth in client numbers outstrips any increase in available funding. While funding models have been developed within the acute health care and education sectors, there have been few attempts to develop funding models for therapy (occupational therapy, physiotherapy, psychology, and speech pathology) provided within community-based, paediatric disability services. This paper outlines a model for allocating staff resources to provide therapy services for children with physical disabilities based on a project conducted by Novita Children's Services (formerly the Crippled Children's Association of South Australia, Inc.). METHOD: Services were mapped using a framework based on the International Classification of Function developed by the World Health Organization and adopted by the Australian Institute of Health and Welfare. An action research methodology was employed that included focus groups held with staff to identify potential resource drivers; collection of travel time data, client caseload numbers; and developing profiles of services and client groups. A model for allocating staff time was developed to reflect the differing service demands, travel time, leave allowances and time for activities to develop the social environment for individuals with disabilities. RESULTS AND CONCLUSIONS: Analysis indicated that the drivers of staff resources were the type of service delivery (early intervention versus school aged services), model specific (e.g., time required to provide community-based services and work within multi-disciplinary teams), and specific client (need for complex technology or equipment; school/preschool transition times; high health care needs due to dysphagia, deteriorating conditions with changing needs, or post surgery/medication rehabilitation) and family well-being issues. While further data collection and refinement of the model is needed, it provides the organization with more objective and equitable resource allocation and enables improved advocacy for client needs.

Child↗
PubMed2005

Selfing and resource allocation in Schiedea salicaria (Caryophyllaceae), a gynodioecious species.

Abstract Levels of selfing and resource allocation patterns were investigated in Schiedea salicaria (Caryophyllaceae), a gynodioecious species with high levels of inbreeding depression and nuclear control of male sterility. Selfing levels were higher in hermaphrodites than females, especially when adjusted for early acting inbreeding depression. The sexes of S. salicaria were similar in most allocation patterns including number of flowers and capsules per inflorescence, seeds per flower, and seed mass. Seeds produced by females had higher levels of germination than seeds of hermaphrodites, a likely result of high selfing levels and the expression of inbreeding depression in the progeny of hermaphrodites. Invasion of females in populations of S. salicaria is probably related to the expression of inbreeding depression at germination and in later life history stages. Comparisons with related species of Schiedea that also have nuclear control of male sterility suggest that reallocation of resources in hermaphrodites to male function occurs as females increase in frequency, but that resource reallocation is not important for the success of females when they first invade populations.

Caryophyllaceae↗
PubMed1998

A resource-allocation model to enhance productivity of academic physicians.

The authors describe a resource-allocation model developed in the Medical Care Clinical Center at the Baltimore Veterans Affairs Medical Center (a part of the VA Maryland Health Care System) and implemented in 1989. This model is a computer-based system that tracks the workload of each of the clinical center's specialty sections (e.g., cardiology) and calculates each section's workload as a percentage of the total clinical center workload. As the basis of this calculation, six activities of each section are tracked by the model (e.g., inpatient attending physicians' rotations; inpatient consultations; etc.) to determine what percentage of each activity of the entire clinical center was provided by each section. Each of these percentages is then recalculated according to a weighted average based on the relative value of the activity to the department; these averages are revised periodically as needed. The model provides an incentive for the specialty sections to increase productivity by generating competition among sections for physician salary support. Communication among all concerned at the clinical center and its associated medical school and teaching hospital has been the key to success in implementing the model, which is periodically reviewed and has been revised several times after meetings with section chiefs and division heads. The authors are confident that the use of the model has been at least partly responsible for increased productivity of clinical center physicians, especially in the areas of visits per physician and funded VA research dollars per physician. Perhaps equally important is the future potential of the model. Because of its simplicity and because it is generally seen to be fair and effective, it will continue to be used to reward activities most important to the clinical center, especially now that the center operates under a fully capitated system, and in this way wil help ensure the financial viability of the center.

Academic Medical Centers↗
PubMed2004

Diet quality and resource allocation in the zebra finch.

We investigated the effect of diet quality on resource allocation in zebra finches (Taeniopygia guttata) by providing females with a high-quality (HQ) or low-quality (LQ) diet for six weeks prior to pairing, and continuing these diets during egg laying and chick rearing. Diet treatments were then reversed and the experiment repeated. When females laid on the HQ diet, egg mass increased with laying order, but the reverse was true on the LQ diet. Females laid significantly more male eggs on the LQ diet compared with on the HQ diet. In addition, female eggs were more frequent at the end of the clutch when on the HQ diet and at the beginning of the clutch when on the LQ diet. These differences in the primary sex ratio are in line with predictions from sex allocation theory, since in this species females are more vulnerable to nutritional stress than males.

Animal Nutritional Physiological Phenomena↗
PubMed1983

Planning and politics of resource allocation for primary health care: promotion of meaningful national policy.

Securing resources for primary health care (PHC) involves consideration of the entire health sector: the higher levels of the health service as well as the primary level, and the private and/or social security sub-sectors as well as the government service. Reshaping resource distribution is less a redistribution of existing resources than the allocation of new resources in accordance with PHC priorities. In this the planning of future current costs is a crucial element and requires a budgetary system that identifies expenditures by geographical area and level of care. Resources should be allocated geographically to reduce health care inequalities through the provision of an appropriate mix of different levels of care. Central resource planning and local health care programming (with 'dialogue' between the two) should be the basic planning division of labour, which largely resolves the so-called top-down/bottom-up dichotomy. The private medical sub-sector exerts economic, ideological and political influences on the public health service. Compulsory health insurance schemes can have some similar effects. Success of a PHC policy requires that governments adopt a holistic approach to the health sector. The allocation of health care resources on the bases of need and equity, as opposed to demand, is a political decision. The establishment of a national PHC policy backed up by adequate resources involves a specific politico-technical exercise with four components: research, planning, policy formulation, and government policy decision-making. The resource planning method, based on social epidemiology, is contrasted with conventional health planning methods, based on epidemiology. The articulation of these two approaches is discussed in terms of WHO's Managerial Process for National Health Development.

Costs and Cost Analysis↗
PubMed2004

[Growth and resource allocation pattern of Artemisia frigida under different grazing and clipping intensities].

In order to understand the degradation process and its mechanism of typical steppe in Inner Mongolia, this paper studied the growth and resource allocation pattern of Artimisia frigida under different grazing and clipping intensities(no grazing, light grazing 1.33 sheep.hm-2, moderate grazing 4.00 sheep.hm-2, heavy grazing 6.67 sheep.hm-2, proportional clipping and stubble clipping), which was conducted at the Inner Mongolia Grassland Ecosystem Research Station of Chinese Academy of Sciences(43 degrees 26'-44 degrees 08' N, 116 degrees 04'-117 degrees 05' E). The results showed that the regrowth ability of A. frigida under proportional clipping was superior to that under stubble clipping, and light clipping (1/4 proportional clipping or 10 cm stubble clipping) was superior to no clipping. In early growth season, the net regrowth of A. frigida was higher under no clipping than under light clipping, but reversed in late growth season (after mid-August). The biomass allocation pattern of A. frigida was roots > leaves > stems. Grazing or clipping affected biomass allocation significantly, especially for the allocation of leaves and flowers. The biomass allocation of leaves was significantly higher under 3/4 proportional clipping or 4 cm stubble clipping than under other treatments, and reverse trend was true for the biomass allocation of flowers. There were no significant differences in biomass allocation of roots and stems among treatments. Sexual reproductive allocation decreased with increasing grazing or clipping intensities, and reproductive mode of A. frigida changed under heavy grazing. The changes in priority of biomass allocation from sexual reproductive organs to clonal growth to sustain and propagate population were important ecological strategies of the species to heavy grazing.

Animal Husbandry↗
PubMed2004

Quality of life: the contested rhetoric of resource allocation and end-of-life decision making.

The term"quality of life" has a long history in the bioethics literature. It is usually used in one of two contexts: in resource allocation discussions in the hope of arriving at an objective measure of the worth of an intervention; and in end-of-life discussions as a concept that can justify the forgoing of life-sustaining treatment. In both contexts, the term has valid uses as it is meant to measure the efficacy of a treatment. However, the term has the unfortunate rhetorical problem that it often seems to be a judgment on the life of a human being. As such, it is highly inflammatory. We suggest that a return to a rhetoric that suggests a judgment on the treatment rather than the person is needed.

Aged↗
PubMed2004

Resource allocation, hyperphagia and compensatory growth.

Organisms often shown enhanced growth during recovery from starvation, and can even overtake continuously fed conspecifics (overcompensation). In an earlier paper (Ecology 84, 2777-2787), we studied the relative role played by hyperphagia and resource allocation in producing overcompensation in juvenile (non-reproductive) animals. We found that, although hyperphagia always produces growth compensation, overcompensation additionally requires protein allocation control which routes assimilate preferentially to structure during recovery. In this paper we extend our model to cover reproductively active individuals and demonstrate that growth rate overcompensation requires a similar combination of hyperphagia and allocation control which routes the part of enhanced assimilation not used for reproduction preferentially towards structural growth. We compare the properties of our dynamic energy budget model with an earlier proposal, due to Kooijman, which we extend to include hyperphagia. This formulation assumes that the rate of allocation to reserves is controlled by instantaneous feeding rate, and one would thus expect that an extension to include hyperphagia would not predict growth overcompensation. However, we show that a self-consistent representation of the hyperphagic response in Kooijman's model overrides its fundamental dynamics, leading to preferential allocation to structural growth during recovery and hence to growth overcompensation.

Animals↗
PubMed2006

Adventitious root production and plastic resource allocation to biomass determine burial tolerance in woody plants from central Canadian coastal dunes.

BACKGROUND AND AIMS: Burial is a recurrent stress imposed upon plants of coastal dunes. Woody plants are buried on open coastal dunes and in forested areas behind active blowouts; however, little is known about the burial responses and adaptive traits of these species. The objectives of this study were: (a) to determine the growth and morphological responses to burial in sand of seven woody plant species native to central Canadian coastal dunes; and (b) to identify traits that determine burial tolerance in these species. METHODS: Field experiments were conducted to determine the responses of each species to burial. Saplings were exposed to burial treatments of 0, 10, 25, 50 and 75 % of their height. Burial responses were evaluated based on regressions of total biomass, height, adventitious root production and percentage allocation to shoot, root and adventitious root biomass on percentage burial. KEY RESULTS: Pinus strobus and Picea glauca lacked burial tolerance. In response to the burial gradient, these species showed a strong linear decline in total biomass, minimal adventitious root production that peaked at moderate levels (25-50 % burial) and no change in allocation to shoots vs. roots. The tolerant species Juniperus virginiana, Thuja occidentalis and Picea mariana showed a quadratic response to burial, with little change in biomass up to 50 % burial, but a large decline at 75 %. These species produced abundant adventitious roots up to 50 % burial, but did not alter allocation patterns over the range of burial levels. Populus balsamifera and Salix cordata were stimulated by burial. These species showed linear increases in biomass with increasing burial, produced copious adventitious roots across the gradient and showed a clear shift in allocation to vertical shoot growth and adventitious root production at the expense of the original roots under high burial conditions. CONCLUSIONS: Adventitious root production and plastic resource allocation to biomass are adaptive traits of coastal dune woody plants in central Canada, and provide a basis for assessing burial tolerance in woody plants on coastal dunes throughout the world.

Adaptation, Physiological↗
PubMedDate not supplied

Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy. In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn transmitted automatically to all other CHORAL computers. Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗