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At least 235 records · Page 13Linked to original sources
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↗
PubMed2006

Patient inducement, provider priorities, and resource allocation in public mental health systems.

Public mental health systems are increasingly facing demands from the criminal justice system and social services agencies to provide services and support in cases in which mental illness contributes to crime, homelessness, or poverty. In this article we analyze how policies from outside public mental health systems affect resource allocation within these systems, using examples from criminal justice. These policies use two types of mechanisms: inducing patients to consume treatment (by offering rewards or imposing penalties) and inducing clinicians to provide treatment (by creating priorities). We propose a classification of these social policies based on whether they affect demand through rewards or penalties or supply through priorities. We then relate the classification to data on patients treated in public systems to evaluate the current prevalence and potential for growth in these outside demands. These inducements impose a set of nonobvious costs on other patients who are not targeted by the policies. Furthermore, they create incentives for both patients and providers to modify their behavior in order to take advantage of rewards, avoid penalties, or better compete for resources with prioritized patients. We consider some policy implications for avoiding unintended consequences of these policies.

Crime↗
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↗
PubMed2003

How state-funded home care programs respond to changes in Medicare home health care: resource allocation decisions on the front line.

OBJECTIVE: To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. DATA SOURCES/STUDY SETTING: Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. STUDY DESIGN: Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N = 2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. PRINCIPAL FINDINGS: Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. CONCLUSIONS: Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics.

Aged↗
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↗
PubMed2005

Intelligent initialization of resource allocating RBF networks.

In any neural network system, proper parameter initialization reduces training time and effort, and generally leads to compact modeling of the process under examination, i.e. less complex network structures and better generalization. However, in cases of multi-dimensional data, parameter initialization is both difficult and time consuming. In the proposed scheme a novel, multi-dimensional, unsupervised clustering method is used to properly initialize neural network architectures, focusing on resource allocating networks (RAN); both the hidden and output layer parameters are determined by the output of the clustering process, without the need for any user interference. The main contribution of this work is that the proposed approach leads to network structures that are compact, efficient and achieve best classification results, without the need for manual selection of suitable initial network parameters. The efficiency of the proposed method has been tested on several classes of publicly available data, such as iris, Wisconsin and ionosphere data.

Algorithms↗
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↗
PubMed1993

Increasing resource allocation and research into tobacco control activities: a comprehensive approach including primary prevention, treatment and brief intervention.

The range of tobacco control activities should be viewed as essential parts of a complex multi-component puzzle. Intervention strategies designed to address tobacco control should be comprehensive and include both primary and secondary prevention activities and be multi-faceted and capable of bringing about change at both the individual and broader social and cultural levels. In this paper I argue for a mutually inclusive framework in which the various components contribute in important and different ways. I examine the prevalence of smoking and identify the high risk groups, then I examine the range of available strategies and present the evidence for their success. I discuss the primary prevention approaches such as warning labels, taxes, price increases, workplace bans, education in schools, mass media and self-help materials, as well as brief interventions and treatment strategies which are conducted at the worksite, general practice and specialized cessation clinics. The areas for future research are delineated for increased resource allocation and include: the best ways to disseminate brief interventions to smokers, methods to motivate smokers; training of health professionals to deliver brief interventions; enhancing quitting and access to existing treatment resources among specific disadvantaged minority groups, e.g. migrants, unemployed youth, the effect on smoking prevalence of warning labels on cigarette packets and price rises on cigarettes.

Journal Article↗
PubMed2001

Deprivation and mortality: the implications of spatial autocorrelation for health resources allocation.

This paper aims at investigating whether the relationship between mortality and socio-economic deprivation is affected by the spatial autocorrelation of ecological data. A simple model is used in which mortality (all-ages and premature) is the dependent variable, and deprivation, morbidity and other socio-economic indicators are the explanatory variables. Deprivation is measured by the Townsend index; the other socio-economic variables are the median income, unequal income distribution (Gini coefficient) and population density. Morbidity is estimated on the basis of hospital admission rates and overweight prevalence. Spatial autocorrelation is measured by the Moran's I coefficient. All mortality and morbidity variables have significant, positive, and moderate-to-high spatial autocorrelation. Two multivariate models are explored: a weighted least-squares model ignoring spatial autocorrelation and a simultaneous autoregressive model. The paper concludes that spatial autocorrelation has a significant impact on the relationship between mortality and socio-economic variables. Future ecological models intended to inform health resources allocation need to pay greater attention to the spatial dimension of the data used.

Belgium↗
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↗