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At least 469 records · Page 26Linked to original sources
PubMed2006

Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework.

Concern has increasingly been expressed at the low level of impact that economic evaluations have on the priority setting decisions they are designed to inform. The concern to maximise the impact of economic evaluation in health care is reminiscent of research utilisation debates rehearsed in the various policy studies disciplines. This paper draws on selected themes and frameworks from this literature in order to explore issues and map out an agenda relating to the uptake and use of cost effectiveness analysis in health policy decisions. The authors consider the implications for health economics, and other policy-related research and evaluation, of adopting either a rational or interactive model of research utilisation. Economic evaluations can be normative or descriptive decision tools. The choice of approach will reflect the assumed model of research utilisation and has implications for overcoming barriers to impact on policy. There is an underlying conceptual link between the rational model of research utilisation, the normative approach to economic evaluation and a focus on barriers to the accessibility of published analyses. In contrast, acknowledgement of an interactive and incremental policy process predisposes the analyst to a more descriptive approach and suggests the importance of broader systems, process and ethical barriers to the use of economic evaluation. We address the crucial issue of the importance of establishing objectives and discuss how this issue effects how those seeking to influence policy should proceed. Finally, we discuss indirect or 'enlightenment' models of research utilisation and the implications of these for the community of health economists.

Health Care Rationing↗
PubMed2005

"Quick and dirty numbers"? The reliability of a stated-preference technique for the measurement of preferences for resource allocation.

We investigated the reliability of an internet-based stated-preference survey to elicit preferences for priority setting using a conjoint study like approach. Preferences were elicited among members of an Internet survey panel in an experimental "allocation of points" task at two times. The main finding is that the survey showed good reliability and most participants consistently adjusted their allocations of points to differences in presented scenarios. At the repetition of the survey, respondents were more likely to prioritize between new treatment programs competing for funding and those that did prioritize discriminated stronger between programs. We found no evidence that respondents were making easy choices or arbitrarily "clicked" through the survey.

Adult↗
PubMed2004

Using mobile telephones: cognitive workload and attention resource allocation.

Driver distraction is recognized as being one of the central causes of road traffic incidents and mobile telephones are tangible devices (among many other electronic devices) that can distract the driver through changes in workload. Forty participants completed a motorway route characterized by a low level of road complexity in the form of vehicle handling and information processing. A peripheral detection task (PDT) was employed to gauge mental workload. We compared effects of conversation type (simple versus complex) and telephone mode (hands-free versus handheld) to baseline conditions. The participants' reaction times increased significantly when conversing but no benefit of hands-free units over handheld units on rural roads/motorways were found. Thus, in regard to mobile telephones, the content of the conversation was far more important for driving and driver distraction than the type of telephone when driving on a motorway or similar type of road. The more difficult and complex the conversation, the greater the possible negative effect on driver distraction.

Adult↗
PubMed2003

What does a fly's individual fecundity pattern look like? The dynamics of resource allocation in reproduction and ageing.

Reproduction is usually characterised by an average fecundity pattern having a maximum at earlier ages and a subsequent gradual decline later on. An individual fecundity trajectory does not follow such a pattern and has no maximum. A three-stage pattern, which includes maturation, maturity and reproductive senescence, is a more appropriate description. An analysis of the power balance of an adult female fly during its life course allows us to predict two critical periods in an individual life history. The first crisis occurs at early ages when the increasing power demand becomes greater than the power supply. It often results in premature death. The surviving flies enjoy maturity and lay eggs at a presumably constant rate. The second critical period at advanced ages ends up in a senescence-caused death. Our approach predicts that there will be a bimodal death time distribution for a population of flies.

Aging↗
PubMed2001

Intrahousehold resource allocation and child growth in Mozambique: an ethnographic case-control study.

This study examines the effect of intrahousehold cash income control and decision-making patterns on child growth in the rural town of Sussundenga in Manica Province, Mozambique. A case-control study design was used to examine the influence of men's and women's disaggregated cash incomes on child growth. The research tested whether greater maternal share of household cash income was associated with (1) increased maternal decision-making and bargaining power in the household, and (2) better child growth. Fifty case households, with children 1-4 years old exhibiting poor growth, were matched with 50 control households of similar socioeconomic status in which all children under five demonstrated healthy growth. Data were gathered on gender-specific income generation and expenditure, specific intrahousehold allocation processes, diet, and sociodemographic variables using a formal survey. Key informant interviews, focus groups, and observation over one year provided ethnographic context for the case-control findings. Case-control differences were analyzed using McNemar's test, paired t-test, and conditional logistic regression. In spite of matching households for socioeconomic status, control household incomes were still slightly greater than cases. Male spouse income was also higher among controls while maternal income, and maternal proportion of household income, were not significantly different. Household meat, fish and poultry consumption, and maternal education were significantly greater among control households than cases. Greater maternal share of household income was not associated with greater maternal decision-making around cash. However, mothers must spend what little cash they earn on daily food supplies and usually request additional cash from spouses to cover these costs. There is evidence that if mothers earn enough to cover these socially prescribed costs, they can spend cash for other needs. Above this threshold, women's earnings may confer more bargaining power. The research also revealed a nuclearization of households, attenuation of community bonds of mutual aid, and increasing importance of cash for survival.

Adult↗
PubMed1999

Risk adjustment and hospital cost-based resource allocation, with an application to El Salvador.

Ignorance about the costs, case loads and case mixes of different hospitals within the public health system constitutes an important obstacle to reforming health care spending in many developing countries. National (tertiary) hospitals generally receive significantly larger budgets, per patient, than lower-level (district) hospitals. One reason for these differential allocations is the widely held belief that national hospitals treat persons with more difficult illnesses and persons who are more severely ill than do other, non-national, hospitals. This belief is but a presumption and one that warrants investigation. This paper analyzes expenditures among public hospitals in El Salvador over a 12-year period to address this question. While controlling for patient morbidity, outputs and other characteristics, district hospitals are found to be substantially underfunded relative to national hospitals. Four policy options to redress this situation are examined.

Budgets↗
PubMed2000

Risk informed resource allocation policy: safety can save costs.

During economic doldrums, decision making on investments for safety is even more difficult than it already is when funds are abundant. This paper attempts to offer some guidance. After stating the present challenge to prevention of losses in the process industries, the systematic approach of quantified risk assessment is briefly reviewed and improvements in the methodology are mentioned. In addition, attention is given to the use of a risk matrix to survey a plant and to derive a plan of action. Subsequently, the reduction of risk is reviewed. Measures for prevention, protection, and mitigation are discussed. The organization of safety has become at least as important as technical safety of equipment and standards. It is reflected in the introduction of a safety management system. Furthermore, the design process in a pro-active approach is described and the concept of inherent safety is briefly addressed. The concept of Layer of Protection Analysis is explained and also the reason why it is relevant to provide a cost-benefit analysis. Finally, after comments regarding the cost of accidents, the basics of costing and profitability are summarized and a way is suggested to apply this approach to risk-reducing measures. An example is provided on how a selection can be made from a number of alternatives.

Cost Savings↗
PubMed2001

Prioritizing resource allocation for clinical enhancement: a participative methodology.

The allocation of hospital funding for new and expanded clinical programs can be a difficult but most important task to deal with during the development of the operating plan (budget). Like many other hospitals, York Central Hospital has struggled with this task each year. In order to address this challenge, the hospital has successfully designed and implemented a prioritization process that includes a standardized program proposal and peer evaluation. The process is grounded in the hospital's vision and strategic directions and built on a culture of evidence-based practice.

Economics, Hospital↗