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Vertical equity in health care resource allocation.
This paper introduces this mini-series on vertical equity in health care. It reflects on the fact that by and large equity policies in health care have failed and that there is a need for positive discrimination to promote equity better in future. This positive discrimination is examined under the heading of 'vertical equity'. The paper considers Varian's notion of 'envy' as a basis for equity in health care but concludes that this is not a helpful route to go down. Better it would seem to pursue the idea from Sen of 'freedoms' and 'communitarian claims' (as raised previously by this author). While it is argued that procedural justice is to be preferred in the longer run as a basis for equity there are gains in adopting a short run goal of promoting distributive justice. Some preliminary evidence is presented on the weighting of health gains to reflect such vertical equity concerns.
Resource allocation within Australian indigenous communities: a program for implementing vertical equity.
Given the significant disparities in health and health related disadvantage between Aboriginal and non-Aboriginal Australians, the application of some notion of equity has a role to play in the formulation of policy with respect to Aboriginal health. Aboriginal and Torres Strait Islander has been abbreviated to Aboriginal. There has been considerable debate in Australia as to what the principles of equity should be. This paper discusses the relevance of the principle of vertical equity (the unequal, but equitable, treatment of unequals) to Aboriginal health funding. In particular, the paper advocates pursuing procedural justice as the basis for vertical equity where the focus is on the fairness of how things are done rather than on the distribution of outcomes per se (i.e. distributive justice). Particular attention is paid to how the principle of vertical equity might be handled at a practical level. Details of the approach used in a number of Australian indigenous communities are discussed. It is concluded that there are strong arguments for pursuing procedural justice under vertical equity particularly when there are cultural differences in the way health is defined and when there is importance attached to indigenous involvement in the health care decision making process.
Culture, self-rated health and resource allocation decision-making.
It has been observed that some groups in society tend to report their health to be better than would be expected through more objective measures. The available evidence suggests that while variations in self-assessed measures of health may act as good proxies of mortality and morbidity in homogeneous populations, in some groups, such as the Aboriginal and Torres Strait Islander communities of Australia, these subjective measures may provide a misleading picture. Useful insights into the formation of health perceptions can be drawn from a range of disciplines, in particular, from social comparison theories, models of illness behaviour, survey literature and linguistics. These theories and models help to provide an understanding of the different ways in which illness may be perceived, evaluated and acted upon by different kinds of people. Such considerations can have very direct implications for those planning and evaluating public health programs as well as those responsible for funding such programs.
QTL analysis of a red junglefowl x White Leghorn intercross reveals trade-off in resource allocation between behavior and production traits.
Behaviors with high energetic costs may decrease in frequency in domestic animals as a response to selection for increased production. The aim of this study was to quantify production traits, foraging behavior, and social motivation in F2 progeny from a White Leghorn x red junglefowl intercross (n = 751-1046) and to perform QTL analyses on the behavioral traits. A foraging-social maze was used for behavioral testing, which consisted of four identical arms and a central box. In two arms there was ad libitum access to the birds' usual food, and in the other two there was novel food (sunflower seeds) mixed with cat litter. In one arm with each of the two food sources, social stimuli were simulated by the presence of a mirror. Each bird could therefore feed on novel or well known food either alone or in the perceived company of a conspecific. Egg production, sexual maturity (females), food intake, and growth were measured individually, and residual food intake and metabolic body weight were estimated using standard methods. A genome scan using 104 microsatellite markers was carried out to identify QTLs affecting behavioral traits. Phenotypic growth rates at different ages showed weak associations in both sexes. Sexual maturity and egg weight were not strongly correlated to growth, indicating that these traits are not genetically linked. Time spent in each arm and in the central part of the maze was analyzed using principal component analyses. Four principal components (PC) were extracted, each reflecting a pattern of behavior in the maze. Females with early onset of sexual maturity scored higher on the PC1 reflecting preference for free food without social stimuli, and females with higher egg production scored higher on the PC2 reflecting exploration. Males with an overall higher growth rate and higher residual food intake scored higher on the PC3, which possibly reflected fear of the test situation, and tended to score higher on the PC4 reflecting low contrafreeloading. Significant QTLs were found for PC1 and PC4 scores on chromosomes 27 and 7, respectively. The location of the QTLs coincided with known QTLs for growth rate and body weight. The results suggest a trade-off between energy-demanding behavior and high production and that some of this may be caused by genetic linkage or pleiotropic gene effects.
Resource allocation decisions in U.K. healthcare: do ethics committees have a role?
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Equity and resource allocation in health care.
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Resource allocation in different parts of juvenile mountain birch plants: effect of nitrogen supply on seedling phenolics and growth.
The composition and concentrations of phenolic compounds were studied in the first true leaves, cotyledons, stems and roots of 2.5-week-old seedlings of mountain birch (Betula pubescens ssp. czerepanovii). The differences in secondary compounds among these plant parts were both qualitative and quantitative. In all parts, condensed tannins accounted for more than 50% of the phenolics. In the first true leaves and cotyledons, chlorogenic acid was the most abundant of the HPLC phenolics. The main components in stems were (+)-catechins and rhododendrins whereas in roots, the main components were ellagitannins. The seedlings were grown at three levels of nitrogen supply (very low-N, low-N, moderate-N), and the effect of nitrogen on concentrations of phenolic compounds was studied in all plant parts. The dry weight of all plant parts, except the roots, increased with increased nitrogen. In all parts, the concentration of condensed tannins was higher at lower levels of nitrogen than at moderate-N. The concentrations of total HPLC phenolics and also those of the compound groups of HPLC phenolics were, however, affected only in the first true leaves and roots. The concentrations in the first true leaves were generally higher in seedlings grown at very low-N and low-N than in seedlings grown at moderate-N. The concentrations in roots were highest at low-N. Not all compounds responded to nitrogen supply in the same manner. The changes in concentrations cannot be exclusively interpreted as changes in the accumulation of phenolic compounds, due to dilution caused by the increase in biomass in better nitrogen availability. There were differences in carbon allocation between condensed tannins and HPLC phenolics in seedlings grown at different nitrogen levels.
Resource allocation to state agbiotech research: 1982-1988.
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Phenotypic plasticity and the evolution of trade-offs: the quantitative genetics of resource allocation in the wing dimorphic cricket, Gryllus firmus.
In the wing dimorphic sand cricket, Gryllus firmus, there is a pronounced trade-off between flight capability and fecundity. This trade-off is found both between morphs and within the macropterous morph, in which fecundity is negatively correlated with the mass of the principle flight muscles, the dorso-longitudinal muscles (DLM). In this paper, we examine how this trade-off is affected by a reduction in food and its genetic basis. We find that the relative fitness of the two wing morphs is not changed although both fecundity and DLM mass are decreased. A quantitative genetic analysis shows that the trade-off function is genetically variable but that most of the variation occurs in the intercept rather than the slope of the function. Analysis further indicates a very high genetic correlation between environments (food ration) supporting the hypothesis of a strong functional constraint between reproduction and flight capability.
Resource allocation and bioethics: the Patti Hearst dilemma.
Abstract Medicine has entered an era of high technology, accompanied by expensive investigation and management. Simultaneously, there is increasing recognition of the gap between the costs of medical technology and society's willingness to pay. It is debatable whether medicine recognizes that it is a hostage in thrall to the medical-industrial complex or whether it has wittingly entered the compact to pursue the high-cost, high-technology course. The situation is reminiscent of the events surrounding the kidnap of Patti Hearst - a wealthy heiress who was much later arrested with the gang of robbers. Whether she was hostage or willing accomplice still remains obscure. It is necessary that a body, such as the Cochrane Collaboration, pursues these issues in medicine.
Ethics, resource allocation, and managerial decision making.
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Diversity and stability in communities structured by asymmetric resource allocation.
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State and local resources allocation and the aging.
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Resource allocation for public hospitals in Andhra Pradesh, India.
The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures.
Funding for cancer centers: a challenge of scarce resource allocation.
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Predicting the future: projections help researchers allocate resources.
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Optimizing power in allocating resources to exposure assessment in an epidemiologic study.
We consider an epidemiologic study with a fixed budget, in which resources may be put into increasing sample size or into improving accuracy of exposure assessments. To maximize study power (efficiency), improving accuracy is preferable if and only if the proportional increase in the square of the validity coefficient is more than the proportional increase in total study costs per subject that is required to achieve it. (The validity coefficient is the correlation between the true exposure and the approximate assessment in the study base.) This is most likely to be so if the cost of exposure measurement remains a small proportion of the overall costs per subject. The design with maximum power will not generally have minimum bias in measure of effect, so that alternative optimality criteria are required if this bias is important.