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PubMed2001

Is subjective well-being a useful parameter for allocating resources among public interventions?

Scarce public resources require trade-offs between competing programs in different sectors, and the careful allocation of fixed resources within a single sector. This paper argues that a general quality of life instrument encompassing health-related and non-health-related components is suitable for determining the best trade-offs between sectors. Further, this paper suggests that subjective well-being shows the properties crucial to a general quality of life measure and has additional advantages that makes it particularly useful for the allocation of public and health care resources. The paper argues that Western societies are in an unusually prosperous situation today which allows to concentrate efforts not only on reducing harm but also on improving positive states of health. Further, subjective well-being can be evaluated from the patient's perspective and incorporates a valuation of life expectancy. Criteria required for an appropriate questionnaire that measures subjective well-being are presented.

Cost-Benefit Analysis↗
PubMed1994

Minnesota public opinion on health care resource allocation.

Creating workable policies for allocating or rationing finite health care resources to meet the needs of individuals as well as the broader society vexes policymakers, providers, and consumers. This paper presents results of a March 1994 Lou Harris survey of 1,006 Minnesotans about health care allocation. Minnesotans believe that allocative or rationing decisions are inevitable and can be discussed. Individualized bedside allocative decisions are preferable to categorical or universal exclusions of some health care benefits. People want comprehensive health care and are willing to let sound clinical judgment, perhaps informed by practice guidelines, selectively withhold some services. The integrity of plan-based allocation or rationing may be best secured and safeguarded by standards that ensure that the decisions are based on patients' best interests, involve trusted clinical decision makers, and include lay participation in the decision making.

Adolescent↗
PubMed1989

Comparison of two scores for allocating resources to doctors in deprived areas.

Current proposals in the general practitioner contract include additional payments to doctors working among deprived populations. The underprivileged area score will be used to identify local authority wards with the greatest levels of deprivation, thus acting as the basis for distributing considerable resources. Two methods of identifying deprived populations--the underprivileged area score and the material deprivation score--were compared to determine whether they result in similar allocation of resources to regions. Financial allocations to regions based on figures derived from the contract differed considerably if the material deprivation score was used instead of the underprivileged area score: Northern and Mersey regions gained over 50% of their allocation whereas East Anglia, Oxford, and South West Thames regions lost more than 30% of theirs. Such differences have considerable implications for doctors working among deprived populations as up to 60m pounds each year might be distributed by these payments.

England↗
PubMed1987

Waiting for care. Queuing and resource allocation.

Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days for nonemergency care leading to hospitalization, including primary and specialty ambulatory care, for that one quarter of patients who had been placed on a waiting list. Of the remaining hospitalized population one half were admitted immediately and another one fourth were either booked or transferred from other hospitals. The widely accepted notion that a large majority of hospitalized patients wait a long time for care in Britain is mistaken. The emphasis on primary ambulatory care means that essentially no one has to wait for general practitioner care. The wait for elective ambulatory specialty care averaged approximately 8 weeks for all patients. Although mortality is rarely an issue for those who wait, an argument can be made that convenience and quality of life are importantly affected.

Ambulatory Care↗
PubMed1992

Decisions near the end of life: resource allocation implications for hospitals.

CONCLUSION: At a time when hospitals are having predictable difficulty accommodating infinite expectations with finite resources, there are still some observers who abhor even the possibility that the cost and volume of hospital services to the terminally ill be scrutinized. However, more assertive attention is justified on the basis of qualitative as well as quantitative evidence. Neither unrestricted medical paternalism nor total patient autonomy should be unequivocally endorsed. Both the physician and the patient have a mutual obligation and incentive to achieve a proper balance. This balance is dynamic rather than static because attitudes and values change, and advance directives are not immutable documents. Hospitals have a moral imperative to create an organizational environment in which a genuine collaborative decision-making process will ultimately benefit all participants.

Administrative Personnel↗
PubMed2004

[Indices of public health services and resource allocation from the Health Ministry of Chile].

BACKGROUND: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. AIM: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. MATERIAL AND METHODS: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. RESULTS: The first two main components were selected, with an accumulated percentage of explained variability of 63.05%. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and very poor populations and public health insurance beneficiaries, to take care of in each Health Service. CONCLUSIONS: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined.

Chile↗