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PubMed1996

Allocating resources for child welfare services: the effect of a caseload-driven approach.

The authors examine the unintended effects of a funding mechanism based on historical caseload statistics on the number of recorded investigated child abuse and neglect reports in seven California counties from January 1985 to December 1992. Forecasting results show that in five out of the seven counties, in the presence of an allocation methodology based solely on caseload statistics, the number of recorded investigated reports was approximately three to thirty-five percent higher than it would have been had only population measures been used. The findings suggest that a funding mechanism based solely on population measures may eliminate the unintended effects of increasing child welfare caseloads.

California↗
PubMed1996

Economic issues in the development and use of practice guidelines: an application to resource allocation in dentistry.

In this paper, the extent to which practice guidelines using cost-effectiveness data can be used to inform programme decisions is analysed. In particular it is shown that guidelines aimed at informing individual patient-provider decisions are unable to reflect the economic concepts that are required to inform public decisions concerned with making best (i.e., most productive) use of the resources available to serve defined populations. The research on which practice guidelines are based represents an important but incomplete source of information for taking decisions about which clients to serve, with which services, and when in the disease process, in the context of provision of services to groups or populations. Moreover, the inappropriate use of 'individually focused' guidelines to inform 'collectively-focused' decisions can lead to more harm than good. An alternative approach for dealing with the difficult choices faced by decision makers involved in public programmes is identified. An illustration of the proposed approach is presented concerning the provision of pit and fissure sealants to children served by a public health clinic.

Child↗
PubMed1997

Resource allocation and physician liability.

Lawyer Karen Capen says funding cutbacks that have affected the services physicians can provide may cause legal problems for Canada's doctors. If cutbacks affect the care that is being provided, they should be discussed with the patient and noted on the chart. She says physicians have "good reason to be concerned" about increasing pressures that create an imbalance between health care resources and the demand and need for services. For some doctors, these have resulted in court cases.

Canada↗
PubMed2002

Drug reimbursement: indicators of inappropriate resource allocation.

AIMS: In many countries, governments and third parties find themselves paying for (reimbursing) unproven, inadequate products limiting their ability to invest in therapies with evidence of relevant patient benefit. We examined how three characteristics, level of therapeutic evidence, susceptibility of inappropriate prescribing, and intercountry variation can be used to identify inefficiencies in pharmaceutical reimbursement among four European Union countries, Austria, Belgium, the Netherlands and Sweden. METHODS: Specific classes of medicines were chosen to provide useful examples of how healthcare resources could be reallocated. A high level of therapeutic evidence was defined as a substantial body of evidence in at least one indication with clear-cut support of relevant patient benefit. The susceptibility of inappropriate prescribing was defined as the likelihood of prescribing a drug outside the scenario for which clear-cut evidence (if any) has been documented to produce relevant benefit for the patient. The intercountry variation represents the variation in utilization of reimbursed drugs across the four countries. RESULTS: The combination of these characteristics provides a useful tool for assessing appropriate reimbursement decisions. It would be beneficial to healthcare payers as well as patients to move resources from products that have a low level of therapeutic evidence and a high susceptibility of inappropriate prescribing to products with a high level of therapeutic evidence and low susceptibility of inappropriate prescribing, and to use intercountry variation as a signal of drug classes that should be subject to further scrutiny. CONCLUSIONS: A method is presented to help policy-makers identify inefficiencies in the spending of limited health care resources, and to reallocate resources to products that have been shown to improve patient care through evidence-based medicine.

Austria↗
PubMed2000

Cyclone mitigation, resource allocation and post-disaster reconstruction in south India: lessons from two decades of research.

This paper opens with a history of development and disaster-prevention strategies in a cyclone-prone area of the east coast of India and traces the evolution in the area of British and Indian governments' programmes and policy over a century. Research over the last 20 years has shown, however, that the programmes and policies have failed to balance economic growth with safety. Resources intended for the benefit of all have been diverted by alliances of powerful people to a small minority, and recent developments have reduced the physical protection of the area. The result is that increasing numbers of people are vulnerable to the effects of cyclones and floods. The findings suggest that the best way to reduce vulnerability is to improve the socio-economic standing of the most vulnerable and for this to happen these people must have an assured income based on assets that will enable them to acquire social and economic credit-worthiness within the local economy. This paper presents evidence that suggests that non-governmental organisation (NGO)-supported co-operatives are the best way to achieve this through self-help and self-employment schemes. It also suggests that NGOs should be encouraged to take up environmentally and ecologically beneficial activities involving the poorest groups in the communities, in this way combining sustained self-employment with environmental protection.

Community Participation↗
PubMed1992

Comparing need with resource allocation.

In a study of health visitor caseloads in Bristol and Weston health authority, 16,000 families were assessed against 26 criteria known by health visitors to affect long term health. Considerable variations were found in the long term risk to the health of individual families. Families with high levels of health risk were concentrated in the caseloads of some health visitors and in a few geographical localities. The results suggest that there is a serious misallocation of health visiting resources and that steps should be taken to adjust resources to reflect more closely the patterns of need.

Community Health Nursing↗
PubMed2002

Equity and resource allocation in health care: dialogue between Islam and Christianity.

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community in terms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services.

Christianity↗
PubMed1990

Allocating resources.

This article reviews the methods of economic evaluation of health technology. The different forms of evaluation are outlined and the importance of assessing costs and benefits at the margin stressed. The approaches used by economists to analyze priorities for health technologies are discussed and a number of key managerial and policy issues identified. It is concluded that, while further methodological improvements can be made, a clear methodology for economic evaluation of health technologies has been established. However, attention needs to be paid to the timeliness and relevance of economic evaluation in order to ensure its maximum impact.

Cost Allocation↗
PubMed1981

The association between frequency of diagnostic radiological examinations and allocation of resources in the National Health Service: implications for future demand.

A highly significant association is noted between the frequency of diagnostic radiological examinations and the relative level of funding in the English Regional Health Authorities as calculated by the Resource Allocation Working Party in 1977 (DHSS, 1976). It is argued that this supports the recommendations of the Resource Allocation Working Party, and their suggestion that Standardized Mortality Ratios can be used as a proxy measure for morbidity. The finding implies that the level of diagnostic radiology is likely to rise if more funds become available, and this conclusion is supported by consideration of the level of diagnostic radiology in other industrialized countries. The correlation with level of funding is also investigated for a number of other indicators of hospital use. Strong associations exist for some usage indicators for out-patients, but not for in-patients.

Catchment Area, Health↗
PubMed1997

Educational opportunities and challenges in poultry science: impact of resource allocation and industry needs.

Because the number of Poultry Science departments in the U.S. has declined dramatically, and because scientist years and research funding for poultry, relative to other commodities, have also declined, a survey of poultry meat companies was conducted. Objectives of the survey were: to evaluate corporate concern over the status of Poultry Science departments, to categorize hiring patterns, to determine expectations for prerequisite skills of graduates, and to ascertain attitudes toward hiring of Associate-degreed students (A.S.). A two-page survey was distributed to corporate Vice Presidents or Directors of Human Resources of the 17 largest broiler and 10 largest turkey companies. When asked to gauge the difficulty they encountered in locating adequate numbers of Poultry Science graduates, 83% noted at least some difficulty. All respondents indicated concern over the loss of poultry programs in the U.S. and 44% noted "extreme" concern. There appears to be little resistance to hiring 2-yr A.S. degree graduates in Poultry Science. The relative scarcity of these programs is demonstrated by the fact that only one-third of the respondents had ever hired A.S. degree graduates. However, greater than 80% of the firms indicated they would hire these students. Finally, communication and business skills were more highly rated by human resources management than technical ability in Poultry Science. Given these results, academic programs must: develop curricula that reflect market-place expectations, enhance the efficiency of resource utilization, embrace new technologies that provide novel methods for information delivery, and reassess cooperative linkages among industrial and governmental organizations.

Animal Husbandry↗
PubMed1985

Physician objectives and resource allocation.

This paper examines the theoretical incentives affecting physicians input use in the case of fee-for-service practice. It establishes that while the price taking physician, acting as a utility maximizer, may use inputs relating to his own time efficiently, he may not be efficient in his use of other inputs.

Canada↗
PubMedDate not supplied

Effects of genetic selection for high or low antibody response on resistance to a variety of disease challenges and the relationship of resource allocation.

Lines of white leghorn chickens were selectively bred for either a high (H) or low (L) antibody response to sheep erythrocytes. The parental lines, HH and LL, and reciprocal crosses, HL (sire line cited first and dam line second) and LH, were compared for their responses to various diseases. High antibody titers were associated with reduced body weight. Lines and their crosses were challenged with infectious diseases. The LL line was most resistant to Mycobacterium avium, whereas the HH line was most susceptible. The HH line was most resistant to Mycoplasma gallisepticum, whereas the LL line was most susceptible. These findings indicate that defense against infectious diseases are resource expensive. In order to save resources, it is possible that different parts of a population might genetically devote high levels of resources against different types of diseases so that the entire population is not susceptible to a single infection.

Animals↗
PubMed2001

Death in Scotland and nineteen years of resource allocation.

The Scottish Health Authorities Revenue Equalisation (SHARE) programme has been operating since the late 1970s to allocate health services money on a more equitable basis between health boards. It is about to be replaced by a new method, however. The trends in per capita spending on healthcare services from the commencement of SHARE are examined here, as are changes in the relative experiences of mortality, in the 12 Scottish mainland health board regions. Every health board has committed increases in spending in real terms on services for their residents. Concurrently, the differential in boards' spending on their residents has reduced due to the effects of the SHARE process. Notwithstanding the global increase in expenditure on healthcare services, and the reduction in inequalities in resources between regions, inequality in the experience of mortality has increased within Scotland. The most important public health factors influencing mortality lie outside the control of healthcare providers.

Health Care Rationing↗
PubMed2000

Risks of hazardous waste sites versus asteroid and comet impacts: accounting for the discrepancies in U.S. resource allocation.

Approximately $6 billion is spent annually in the United States on the cleanup of sites regulated under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA, or Superfund). The current health risks posed by such sites are thought to be quite small; the expenditures are justified primarily as protecting hypothetical future residents of these sites. Approximately 0.05% of this amount, or $3 million, is spent annually by the U.S. government on the detection of asteroids or comets that could strike the earth. Such damaging impacts do occur from time to time--most recently in 1908 in an unpopulated region of Siberia--but no person is confirmed ever to have died as a result. Anticipated impacts over the course of 1 million years would yield deaths that, when annualized, total approximately 4,000 per year. The risk reduction goal for CERCLA is 15 orders of magnitude greater than that for asteroid/comet detection. A modest increase in resources devoted to asteroid detection would greatly increase the chances of early detection of a threatening object, allowing an effective defense to be attempted. This article argues that the much lower risk-to-resources ratio for CERCLA cleanups than for asteroid and comet detection can be explained by four primary factors: (1) the regard for future generations, since CERCLA benefits mainly the unborn; (2) concrete fears, since toxics are much more feared than asteroids or comets; (3) the source of the threat, since toxic contamination is caused by human beings, unlike impacts from space objects; and (4) the greater political constituencies for hazardous waste cleanup than for space object detection.

Journal Article↗
PubMed2004

[Networking as an opportunity to profile a clinic? Strategy options after the evaluation of resource allocation].

BACKGROUND AND OBJECTIVES: Diagnosis-related groups of medical services has recently been introduced for reimbursing hospital services. The aim has been to optimize bed capacity, decrease the duration of inpatient stay and provide good follow-up medical care. This confronts hospitals with the need for closely cooperating with the referring general practitioners or specialists. METHOD: A specially structured questionnaire was sent to all those general practitioners and specialists (n=890) who had referred patients to a university department of dermatology. The response rate was 23%. The completed questionnaires were analysed with respect to criteria judged to be important in determining referral for inpatient care and the quality of medical and related service provisions. RESULTS: Especially important to the referring doctors were optimal competence of patient care, the degree of cooperation and prompt, detailed information after the patients have been discharged. CONCLUSION: This type of analysis can serve to optimize the course of diagnosis/treatment and to utilize fully the available hospital resources. Also considered are various ways in which a hospital department can, by networking with general practitioners and specialists, become a centre for providing optimal services.

Clinical Competence↗
PubMed1997

An analysis of resource allocation in response to dietary yeast in Drosophila melanogaster.

Drosophila melanogaster exhibit an increase in fecundity and a decrease in length of life and starvation resistance when the diet is enriched through the addition of live yeast. It has been proposed that this represents a necessary energetic trade-off between reproductive and somatic functions. We examined the metabolic aspects of this trade-off. We measured egg production, dry wt, somatic lipid and carbohydrate storage, and metabolic rate in response to changing amounts of live dietary yeast. These variables were measured in five replicate populations selected for postponed aging and five replicate short lived control populations. We find that all ten populations show an overall increase in egg production and decrease in the amount of stored metabolites in the presence of increasing amounts of yeast. All populations increase metabolic rate in response to increasing amounts of live dietary yeast. The energetics of this phenomenon suggest that increased egg production results from increased acquisition of nutrients available in yeast with only a small redirection of resources from storage to egg production.

Journal Article↗
PubMed1996

A guide for planning community-oriented health care: the health sector resource allocation model.

The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs). An expanded life-table approach was used for 16 age-and sex-matched cohorts exposed to a disease attack rate, access-to-care rate, case fatality rate, morbidity, and costs. Rates can be modified to reflect changes due to treatment, secular trends, or prevention programs. Two alternative delivery methods were considered to show the potential impact of reducing cardiovascular deaths (worksite initiative), or increasing utilization of services (lay health promotion) on county health status and costs over time. Deaths, bed days, and annual medical payments were the main outcome measurements. Cardiovascular and cancer conditions are and will be the primary causes of death in this population. The most important causes of bed days are musculoskeletal conditions, chronic obstructive pulmonary disease, accidents, strokes, and depression. The major health-care payments are for angina pectoris and/or other cardiac conditions, musculoskeletal conditions, accidents, prenatal care, and/or childbirth, and depression. The two alternative scenarios illustrate how reductions in mortality are not necessarily equated with similar improvements in morbidity or costs. This model presents an overview of the current and projected health status of a community. With such a planning tool, a community can better understand the impact of potential prevention or intervention programs, and help design its health-care system within the constraints of available resources.

Cause of Death↗
PubMed1990

Resource allocation, equity and public risk: dying one at a time vs dying all together.

This paper focuses on the evaluation, from an individual and societal perspective, of risk in terms of possible loss of life due to an exposure to two different types of events over a period of time. The two types are: risk of death from a catastrophic event (a sudden death of many people in a disaster at a yet unknown point in time) expected to occur during a planning period, or risk of death from another event (e.g. disease, road accident, etc) which claims fewer lives each year, but for which the expected total number of deaths over the planning period is equal to the expected number of deaths from the catastrophic event. Our analysis considers the extreme case in which these two types of events have the same probabilities of death every year and the same expected number of fatalities over the planning period. The individual's decision problem is described using a von-Neumann Morgenstern (vNM) utility function. The model suggests that the choice between these types of events depends on the value of the following variables: the probability of death over the planning period, the length of the planning period, the individual's time preference pattern, and the utility of being in different anxiety states. Stochastic extensions that may direct the public decision making process (involving aggregated preferences) are discussed. We also discuss issues of implementation.

Catastrophic Illness↗