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PubMed1993

Resource allocation--the legal implications.

Problems of resource allocation in the many health systems throughout the world are increasingly urgent. Although some argue that the problem is not one of limited resources but of misallocation of resources that would be sufficient if properly used. Most writers agree that there are insufficient resources available to meet demand, requiring action to allocate limited resources. Extensive debate among ethicists, economists, and policy-makers is devoted to determining effective, efficient and equitable methods of allocating limited resources in response to potentially unlimited demand. This paper outlines the problem of resource allocation and examines a recent Australian case in light of the complex problems raised by the need to contain health care costs in a mixed public and private health care system. Legal tensions are created by the possibility that resource constraints may affect the physician's role in caring for the patient, with possible consequences in negligence.

Australia↗
PubMed2004

An alternative approach to resource allocation: weighted capacity to benefit plus MESH infrastructure.

This article outlines an approach to resource allocation in healthcare that embraces the concepts of 'capacity to benefit' and management economic social and human (MESH) infrastructure. Health service jurisdictions differ in terms of their capacities to produce benefits for the people they serve. This is for three reasons: (i) some populations already have relatively good health, so the capacity to benefit further is limited compared with others; (ii) even where the health levels of two populations are similar, one population's health problems can be more amenable to health service interventions, i.e. its capacity to benefit from healthcare interventions is greater; and (iii) even where both the health levels and the health problems are similar, one health service may be better placed or better equipped to deliver benefit to its population than the other. In the case of (iii), the capacity to benefit is inhibited because it lacks the necessary MESH infrastructure to deliver health benefits to its population. The approach to resource allocation outlined in this article differs from the more conventional approaches. While resource allocation working party (RAWP)-type formulae concentrate on allocating resources primarily according to the size of the problem (often called heath need and measured in terms of some assessment of the amount of sickness in a population), the starting point with weighted 'capacity to benefit' plus MESH is to ask what good or benefit is sought in allocating resources. In so far as there are variations in the abilities of different authorities by way of MESH, this can result in uneven implementation of health service interventions and consequent inequities and inefficiencies for the relevant populations. There is a need to address this problem of variation through providing support to those jurisdictions that are deficient in these abilities. The building of MESH infrastructure is to be seen as a major plank in any equity strategy, as it may well be the neediest jurisdictions that are most often lacking in MESH. The lack of MESH in these communities will then exacerbate inequities in service delivery.

Cost-Benefit Analysis↗
PubMed1991

Resource allocation in contemporary paediatrics: the case against high technology.

High technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person-intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.

Australia↗
PubMed2000

The effectiveness of resource allocation methods used by RWCA Title II Consortia in Virginia.

The authors sought to determine the following: (1) How rigorous are the current resource allocation methods used by Virginia's five regional Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II consortia? (2) How useful are existing databases in allocating resources? (3) Is it feasible to introduce a standardized performance measurement approach for state-level assessment of consortia effectiveness? The authors reviewed proposals and progress reports from each of the consortia to the Virginia public health agency; they then visited each of the consortia to solicit information to refine the study questions and to review the consortia's databases. The authors reviewed the literature on existing models used to allocate resources, and surveyed members of the Virginia consortia about how they used various resource allocation tools, how effective these tools were, and how ready the consortia were to be evaluated regarding resource allocation. The authors found no uniform process for the allocation of Title II funds in Virginia. Consortia members who felt connected and involved with their consortium were significantly more knowledgeable about its operations and more likely to consider it effective. A consortium's use of a continuous quality improvement (CQI) approach to allocating resources was strongly associated with its members' perception that the consortium was effective. Statewide performance and/or outcome measures cannot be set without some standardized expectations for performance. To do this, some expectations for basic resource allocation procedures must be established. Three of Virginia's five consortia will make use of this study's instrumentation in their next resource allocation processes, and, if their experiences are useful, a statewide process may be established. If a statewide process is established, regional consortia must continue to be able to determine local needs and to respond with locally appropriate service planning.

Adult↗
PubMed2003

Growth or reproduction? Resource allocation by female frogs Rana temporaria.

The decision how to allocate marginal resources to reproduction and growth can have important effects on associated life-history parameters as well as on population dynamics. In addition to showing variation among individuals in a population, such allocation rules may be either condition-dependent or fixed in different individuals. While many studies on anuran amphibians have focused on egg numbers and egg sizes in females of different sizes, virtually no data exist on the relative allocation of marginal resources to growth versus reproduction. In the laboratory, we therefore offered female common frogs ( Rana temporaria) low versus high food rations for a full reproductive cycle, and monitored their growth and later reproductive investment (egg number and egg size the following breeding season). Feeding rates had an effect both on female growth and on egg number and size. There was no trade-off found between the two forms of investment. A flexible allocation rule could not be supported as there was no significant effect of feeding rate on the relative allocation of resources to growth versus reproduction.

Adaptation, Physiological↗
PubMed1995

[The differences between individualists and cooperators: interpersonal cognition of resource allocation].

The purpose of this article is to study interpersonal cognition of resource allocation and individual differences in the cognition. Sixty subjects participated in an experimental game, and 18 individualists and 16 cooperators were selected according to their tendency in resource allocation, which is called social values. Then, they rated resource allocating behavior. Major findings were as follows: (1) Both groups rated "allocating more resource to the partner" as more socially desirable and friendly. (2) Individualists rated "allocating more resource to self," which was consistent with their social values, as more socially desirable. They also rated "equal allocation with own resource adjusted" as more socially desirable but less dynamic. (3) Cooperators rated "equal allocation with own resource adjusted," which was consistent with their social values, as more socially desirable and friendly. (4) Both groups rated "more resource to self" and "less resource to the partner" as dynamic (active and assertive). The relation between interpersonal cognition and social values is discussed.

Adult↗
PubMed2002

Reflection on the history, coordination, and funding trends for U.S. public meat research: information to enhance resource allocation.

A study was conducted to analyze resource allocation for public meat research in the United States and characterize the portfolio of meat research investments. Trends in the amount of public resources provided for meat research (beef, pork, lamb, and poultry) were analyzed for fiscal years 1980, 1985, 1990, 1995, and 1997. An in-depth analysis was conducted for data from fiscal year 1998 to characterize the profile of the research portfolio. Funding levels and scientist-year equivalents were aggregated to represent the measures of resource allocation for three mutually exclusive research categories: 1) meat quality, 2) food safety, and 3) product development and processing. Data for the 1998 profile analysis were derived from a computer search based on the combination of key words and research classification codes to avoid duplication and cluster research projects. Individual research projects were individually reviewed and a percentage was assigned to four mutually exclusive research categories: 1) meat quality, 2) food safety, 3) product development and processing, and 4) marketing. As meat research evolved over the past century, considerable efforts were expended by researchers and administrators to ensure the coordination of research and program relevance. This is demonstrated by the establishment of numerous multistate research committees. Total funding for meat science increased only modestly when adjusted for inflation during the two decades of this study; however, notable changes occurred in the distribution of resources in the portfolio. Funding for meat quality and product development and processing remained virtually unchanged when adjusted for inflation, whereas funding for food safety increased considerably. The total number of scientists conducting meat research remained virtually unchanged during the period, but the proportion allocated to food safety research increased substantially. The federal portion of total funding decreased from 61.3% to 51.6% between 1980 and 1997, whereas the percentage from both state appropriations and private sources increased. Modifications in research emphasis were influenced by industry problems such as meat quality, public perceptions about food safety, the availability of research funding, scientific advances occurring in molecular biology and genetic manipulation, and the changing meat industry. The information in this paper provides administrators and researchers the opportunity to make better informed decisions about resource allocation for meat research.

Advertising↗
PubMed2001

Resource allocation for epidemic control over short time horizons.

We present a model for allocation of epidemic control resources among a set of interventions. We assume that the epidemic is modeled by a general compartmental epidemic model, and that interventions change one or more of the parameters that describe the epidemic. Associated with each intervention is a 'production function' that relates the amount invested in the intervention to values of parameters in the epidemic model. The goal is to maximize quality-adjusted life years gained or the number of new infections averted over a fixed time horizon, subject to a budget constraint. Unlike previous models, our model allows for interacting populations and non-linear interacting production functions and does not require a long time horizon. We show that an analytical solution to the model may be difficult or impossible to derive, even for simple cases. Therefore, we derive a method of approximating the objective functions. We use the approximations to gain insight into the optimal resource allocation for three problem instances. We also develop heuristics for solving the general resource allocation problem. We present results of numerical studies using our approximations and heuristics. Finally, we discuss implications and applications of this work.

Communicable Disease Control↗
PubMed1996

Does self-regulation require cognitive resources? Evaluation of resource allocation models of goal setting.

The resource allocation model of goal setting (R. Kanfer & P.L. Ackerman, 1989) maintains that self-regulation initiated through goal setting requires attentional resources that could be more productively applied to skill acquisition and complex task performance. The current study questioned this hypothesis because attentional resources had not been directly manipulated or measured in studies supporting the model. Thus, alternative explanations that are based on other complex task goal-setting models cannot be excluded. As a direct test of the resource allocation hypothesis, dual task methodology was used to measure the attentional resource requirements of self-regulation. Even at the limits of human information processing, participants who were assigned difficult, specific goals performed at least as well on the secondary task as did individuals with do-your-best goals. These findings suggest that self-regulation does not necessarily require attentional resources. Implications for theory and practice are discussed.

Adolescent↗
PubMed2002

Geographic patterns of deprivation in South Africa: informing health equity analyses and public resource allocation strategies.

There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. Despite certain data problems, it was possible to construct and compare three different indices: a general index of deprivation (GID), compiled from census data using principal component analysis; a policy-perspective index of deprivation (PID), based on groups identified as priorities within policy documents; and a single indicator of deprivation (SID), selected for relevance and feasibility of use. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country. The inclusion of the GID within this formula would dramatically alter allocations towards those areas suffering from human development deficits. The area in which analysis was undertaken was not, however, sufficiently small to identify pockets of deprivation within the less deprived metropolitan areas. These findings suggest that it is feasible to conduct small area analyses in LMICs but that specific attention needs to be given to the size of the geographic unit used in analysis. In addition, they highlight the importance of considering deprivation in resource allocation mechanisms if vertical equity goals are to be promoted through resource allocation, particularly within decentralized health systems.

Censuses↗
PubMed2006

Equity in resource allocation for health: a comparative study of the Ashanti and Northern Regions of Ghana.

Debate over the equitable allocation of financial resources in the health sector has focused overwhelmingly on allocation from national to regional levels. More equitable allocation of such resources within regions has been virtually ignored, creating a vacuum in knowledge regarding how resources are allocated intra-regionally and their potential influence on promoting health equity. In this paper, we report an empirical study examining progress towards equity in intra-regional resource allocation in the Ashanti and Northern regions of Ghana. Relative deprivation across the 31 districts of the two regions was measured as a proxy of health needs. The result was used to develop an equity-adjusted share index (EAS) applied as a yardstick against which progress towards equity was assessed. The study found a significant correlation between districts' share of donor pooled funds (DPF) and the EAS in the Northern region for three of the 4 years investigated. In Ashanti region, a worsening trend in relation to equity in DPF allocation was discovered. The proportion of variance in the share of DPF that could be explained by the EAS reduced incrementally from 56% in 1999 to less than 1% in 2002. The study highlights the need for more emphasis on intra-regional equity in resource allocation in Ghana.

Ghana↗
PubMed2003

Resource allocation for control of infectious diseases in multiple independent populations: beyond cost-effectiveness analysis.

Traditional cost-effectiveness analysis (CEA) assumes that program costs and benefits scale linearly with investment-an unrealistic assumption for epidemic control programs. This paper combines epidemic modeling with optimization techniques to determine the optimal allocation of a limited resource for epidemic control among multiple noninteracting populations. We show that the optimal resource allocation depends on many factors including the size of each population, the state of the epidemic in each population before resources are allocated (e.g. infection prevalence and incidence), the length of the time horizon, and prevention program characteristics. We establish conditions that characterize the optimal solution in certain cases.

Communicable Disease Control↗
PubMed2003

A province-wide study of the association between hospital resource allocation and length of stay.

The relationship between hospital resource allocation and clinical efficiency is poorly understood. Within the single-payer healthcare system in Ontario, Canada, the association between hospital spending patterns and length of stay was studied using data from 1117090 patient discharges in 1997/8 at 162 of 171 acute care hospitals. A weighted regression model was created using an overall hospital length of stay index (actual length of stay divided by predicted length of stay) as the dependent variable. Control variables included: hospital size, teaching activity, occupancy rate, rural location and geographic region. Four independent spending variables were defined as a percentage of total hospital spending: nursing, ambulatory care, administration and support, and diagnostics and therapeutics. The reduced regression model had an r-squared of 0.45. Across all spending variables, hospitals spending relatively too little or too much had significantly longer length of stay. Hospitals' overall pattern of resource allocation was also significantly associated with length of stay. Thus, measurable clinical effects can be seen with resource allocation decisions made by hospital management, supporting the need for rigorous decision-making processes. Future research should focus on exploring the nature of this relationship and the potential interdependencies among hospital services that cause this effect.

Acute Disease↗
PubMed2004

The impact of diet switching on resource allocation to reproduction and longevity in Mediterranean fruitflies.

Understanding the factors that determine the allocation and utilization of organism resources may provide an insight into the mechanisms of adaptation, ageing and reproduction. Resource allocation, which is regarded as a method of adaptation, increases fitness and is genetically controlled. Experiments with variable diet feeding of female Mediterranean fruitflies (Ceratitis capitata) demonstrated that the feeding regime dramatically influences lifespan, mortality and the reproduction of flies. An analysis of experimental data and numerical experiments reveals that resource allocation could explain lifespan increase when females are switched from a sugar-only to a protein-containing diet. The heterogeneity of the initial female cohort in terms of the total amount of resources and its allocation to the processes of maintenance and reproduction plays a significant role in this.

Adaptation, Physiological↗
PubMed2004

The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations?

Although the English NHS has been described as a world leader in pioneering methods of distributing expenditure in relation to population needs, concerns about the legitimacy of using the current utilisation-based model to allocate health service resources are mounting. In this paper, we present a critical review of NHS resource allocation in England and demonstrate the feasibility and impact of using direct health estimates as a basis for setting health care capitations. Comparing target allocations for the inpatient treatment of coronary heart disease in a sample of 34 primary care trusts in contrasting locations in England, we find that a morbidity-based model would result in a significant shift in hospital resources away from deprived areas, towards areas with older demographic profiles and towards rural areas. Discussing the findings in relation to a wider policy context that is generally concerned to direct more health care resources towards the poor, the paper concludes by calling for greater clarity between the goals of health care equity and health equity. Whilst the former demands that the legitimate needs of demographically older populations for more health care resources are acknowledged, the goal of health equity requires real political commitment to resource broader social policy initiatives.

Adolescent↗
PubMed1999

The role of resource allocation models in selecting clinical preventive services.

OBJECTIVE: To demonstrate the potential value and current limitations of using resource allocation models for selecting health services. DESIGN: To identify the most efficient mix of preventive services that could be offered by a managed care organization (MCO) for a fixed budget, an optimization model (greatest number of life years saved) and a cost-effectiveness model (rank order of most to least cost effective) were developed. Because of the lack of cost-effectiveness analyses that met the study criteria, only 9 preventive services were selected to demonstrate each model. PATIENTS AND METHODS: The 2 models were applied to a hypothetical managed care population of 100,000 enrollees with age, sex, and risk distribution similar to that of the US population. Data for the input variables were obtained from cost-effectiveness studies of 9 preventive services. Model variables included the target population, percent of enrollees who received the preventive service, the cost of the preventive service, life years saved, and cost-effectiveness ratios. RESULTS: The models demonstrated that efficient allocation of finite resources can be achieved. When budgets are limited, different premises between the 2 models may yield different health consequences. However, as the budgets were increased, results from the 2 models were more closely aligned. CONCLUSIONS: Resource allocation models have the potential for assisting MCOs in selecting a set of preventive services that will maximize population health. Before this potential can be fully realized, additional methodological development and cost-effectiveness studies are needed. The use of resource allocation should be examined for selecting all healthcare services.

Budgets↗
PubMed2000

How resource allocation decisions are made in the health care market.

This paper describes how economists view resource allocation decisions in health care markets. The basic economic decisions that must be made in any economic system and the resource allocation decisions in a perfectly competitive market are described. An idealized market can achieve an efficient allocation of resources and is contrasted with a more realistic description of the numerous ways in which health care markets depart from the perfectly competitive ideal. The implications of these departures for health care policy are discussed, along with key controversies concerning reliance upon markets for resource allocation in health care. In particular, the failure of competitive markets to achieve what many consider an equitable distribution of health care is emphasized. The paper concludes with some practical observations on how pharmacists can use the increasing emphasis on economic efficiency to the advantage of their profession.

Decision Making↗
PubMed1986

The ethics of resource allocation in critical care.

Increasingly, the ethics of resource allocation is becoming one of the most critical ethical problems faced by critical care decision makers; what is lacking is a framework for analyzing the ethics of decisions in resource allocation. This article examines the four ethical principles--patient-centered beneficence, autonomy, full beneficence, and justice--that can contribute to cost containment/resource allocation.

Beneficence↗