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PubMedDate not supplied

Allocation of healthcare resources: the case for health promotion.

The issue of healthcare resource allocation is examined from the macro perspective with the view to building a case for health promotion and prevention. The author suggests a health promotion framework as an alternative, or at least a complementary approach, to resource allocation, with the potential, over the long term, to slow the growth of healthcare costs. Supportive and opposing arguments are presented for the case of health promotion. The author concludes with a synthesis of a new perspective for nursing in the struggle to allocate healthcare resources in a fair and just manner.

Cost-Benefit Analysis↗
PubMed1988

Ought the young make health care decisions for their aged selves?

Though the chief responsibility for providing for the health care of older Americans has been (and should remain) society's, there has been increasing interest in private solutions. Individual provision, however, would require not only adequate wealth but prudent planning, demanding in turn more discipline, self-control, and foresightedness than many individuals are normally capable of. One possible corrective is pre-commitment, a strategy of binding oneself to a plan chosen to allocate resources optimally over the life span. Though pre-commitment may have some important uses, however, it is far from clear that people should be encouraged or enabled to rely upon it for old-age health care planning. The present paper examines some of the philosophical and policy concerns attendant to the use of pre-commitment strategies for resource allocation in old age.

Aged↗
PubMed2005

Conserved ontogeny and allometric scaling of resource acquisition and allocation in the Daphniidae.

Life histories vary widely among taxa, but within phylogenetic groups there may be a fundamental framework around which trait variation is organized, perhaps as a consequence of lineage-specific developmental constraints. In organisms with indeterminate growth, there is an ongoing problem of optimally allocating resources between growth and reproduction, and that allocation decision may manifest itself through allometric scaling. Previous work on freshwater zooplankton has shown that the ontogenetic pattern of resource allocation can be described by simple mathematical functions. An important component of understanding how such functions can explain life-history variation is to discover which parameters in these functions are robust, with respect to both resource availability and evolutionary diversification, and which parameters exhibit interspecific allometry. To shed light on these issues, detailed life table experiments were conducted on eight species in the family Daphniidae (Crustacea) at high and low levels of resources. Using data on growth, reproduction, and instar duration, the ontogeny of resource allocation to growth and reproduction could be described as functions that plateau at or shortly after the onset of maturity. To be sure that the results were not an artifact of phylogenetic structure, the parameters were tested in a phylogenetically controlled fashion. The results suggest a simple set of resource allocation rules for daphniids, whereby all species exhibit a similar form of ontogenetic change in allocation, and reach a plateau where approximately 94% of available resources are allocated to reproduction. The asymptotically maximal rate of net resources incorporated in growth and reproduction was positively related to size at maturity, whereas the rates of approach to plateaus (for both net resource assimilation and proportional allocation to reproduction) were negatively related to body size. Per-offspring investment was positively related to the square root of size at maturity. Using this approach, a wide range of interspecific variation in life-history features can be related to a single underlying trait, the size at first reproductive investment.

Adaptation, Physiological↗
PubMed1997

A system to define and allocate health care resources on a territory to improve the life quality of the populations in developing countries.

In this paper the health resource allocation problem is discussed. An object-oriented system is proposed and its implemented prototype is illustrated. It consists of two parts: a Geographical Information System, which is able to acquire and store both geographical and social-epidemiological information (including the resource distribution on that territory), and a Decision Support System, able to decide, using optimization algorithms, the new resource allocation in order to obtain a quasi-optimal solution for the cost/benefit ratio minimization problem, after having fixed the goal (e.g., the decrease of the incidence of a given disease) and constraints (e.g., a fixed budget, a given set of available resources, etc.). The object-oriented database which is part of the system can simulate and store different scenarios, depending on the different goals and constraints defined in input, by means of a user friendly interface.

Algorithms↗
PubMedDate not supplied

The role of the 'lifestyle' label and negative bias in the allocation of health resources for erectile dysfunction drugs: an ethics-based appraisal.

There have been recent calls for the re-evaluation of health resource allocation for erectile dysfunction (ED) drugs. This paper discusses sociocultural prejudices associated with ED and its treatment, arising from the link with sexuality, the perception that ED is a 'lifestyle' issue and the belief that ED is part of the normal ageing process. These views diminish the perceived importance of sexual health, extending subjectively into the funding arena as a 'negative bias'. Empirical data are presented, which demonstrate that ED can have significant psychosocial consequences, and that ED drugs are valuable quality-of-life interventions. The assumption that ED is an inevitable part of ageing is also analysed and found to be questionable. Health resource allocation decisions for ED drugs must be conducted with an awareness of the ethical and clinical complexities described in this paper, and with the sensibility that negative personal value judgments (on the part of policymakers) must be guarded against.

Age Factors↗
PubMed2004

Health care priority setting: principles, practice and challenges.

BACKGROUND: Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). METHODS: This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. RESULTS: At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. CONCLUSION: Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated.

Journal Article↗
PubMed1997

Compensatory control in the regulation of human performance under stress and high workload; a cognitive-energetical framework.

This paper presents a cognitive-energetical framework for the analysis of effects of stress and high workload on human performance. Following Kahneman's (1973) model, regulation of goals and actions is assumed to require the operation of a compensatory control mechanism, which allocates resources dynamically. A two-level compensatory control model provides the basis for a mechanism of resource allocation through an effort monitor, sensitive to changes in the level of regulatory activity, coupled with a supervisory controller which can implement different modes of performance-cost trade-off. Performance may be protected under stress by the recruitment of further resources, but only at the expense of increased subjective effort, and behavioural and physiological costs. Alternatively, stability can be achieved by reducing performance goals, without further costs. Predictions about patterns of latent decrement under performance protection are evaluated in relation to the human performance literature. Even where no primary task decrements may be detected, performance may show disruption of subsidiary activities or the use of less efficient strategies, as well as increased psychophysiological activation, strain, and fatigue after-effects. Finally, the paper discusses implications of the model for the assessment of work strain, with a focus on individual-level patterns of regulatory activity and coping.

Adaptation, Psychological↗
PubMed2006

Nonmedical economic consequences attributable to visual impairment: a nation-wide approach in France.

The nonmedical costs of visual impairment are crucial when allocating resources for prevention or treatment programs. Were analyzed the data from two representative nationwide French surveys aimed at documenting impairments that included 14,603 subjects living in institutions and 16,945 in the community. Three groups were identified: blind (light perception), low vision (loss of shape perception, LV), and controls. Item consumption was standardized on confounding factors using logistic regression. Costs attributable to visual impairment were estimated from control subjects. National nonmedical costs due to visual impairment were euro 9,806 million, arising mostly from LV (euro 8,735 million). The annual average cost/subject was euro 7,242 for LV and euro 15,679 for blindness. Loss of family income was euro 4,552 million, the burden on the caregiver euro 2,525 million, paid assistance euro 2,025 million, social allowances euro 0,942 million, and unmet needs euro 5,553 million. Resource allocation strategies aimed at controlling visual impairment should cover all relevant economic dimensions, including nonmedical items.

Activities of Daily Living↗
PubMed2004

An optimal contract approach to hospital financing.

Existing models of hospital financing advocate mixed schemes which include both lump-sum and cost-based payments. The doctor is generally the unique decision maker, which is unrealistic in a hospital setting where both managers and doctors are involved. This paper develops a model in which managers and doctors are responsible for different decisions within the hospital. In this model, public authorities who provide the financing, hospital managers who allocate resources within the hospital, and doctors who assign patients to either a low-tech or a high-tech therapy have information of increasing quality on the casemix of patients. The public authorities sign with hospital managers contracts specifying some lump-sum financing and some size of a high-tech equipment. In turn, managers, who know the broad mix of patients in the hospital, sign with hospital doctors contracts that specify the non-medical resources allocated to this facility as well as some remuneration. Doctors, who know each patient's illness severity, select the patients to be treated by the high-tech facility, and receive from public authorities some fee-for-service payment that is differentiated according to the low- or high-tech treatment used for curing their patients. What emerges is a two-stage agency problem in which contracts are designed to elicit information in the most efficient way.

Contract Services↗
PubMed1998

Linking measures of health gain to explicit priority setting by an area health service in Australia.

A demonstration project was undertaken to develop an integer programming model that could help a regional health authority to take into account data on service effectiveness when allocating resources to acute inpatient services. The model was designed to find the mix of services that would maximise health gain from the available resources, and so provide information that could be used to encourage hospitals to change their patient mix. It was developed in collaboration with an Area Health Service in New South Wales, Australia, with the aim of assessing its potential as a decision support tool. Acute inpatient services were categorised in the model using classes derived from the Australian National Diagnosis Related Groups (AN-DRG) classification and the classes developed by the Oregon Health Services Commission. Estimates for the effectiveness of each service was derived from the Oregon benefit data. Estimates of resource use were derived from AN-DRG data. The expected demand for each service was derived from local activity data. Various scenarios were developed to assess the potential of the model to support decision makers. These mimicked plausible policy options and tested the sensitivity of the results to changes in the data. The scenarios demonstrated the model could reveal the consequences of different policy options, but also suggested that the difference in the cost-effectiveness of services close to the margin would be small and so a rigid approach to priority setting is undesirable. Difficulties in developing the model also demonstrate that incorporating health gain data into resource allocation decisions will not be straight-forward for health planners.

Cost-Benefit Analysis↗
PubMed1982

Divided attention abilities in young and old adults.

The literature on divided attention and adult aging has not taken age differences in single-task performance into account, and it has not been able to measure divided attention independently of resource allocation strategies. Two experiments are reported that controlled for these factors. In the first experiment, young (18-23 years) and old (57-76 years) subjects made responses to two simultaneous visual displays. Stimulus durations were manipulated to equate single-task performances, and across different conditions subjects were induced to vary the way in which they allocated resources between the two displays. In the second experiment, response time was the dependent variable; dual-task scores were assessed relative to each subject's single-task scores. No significant age difference in divided attention ability independent of single-task performance level was found in either experiment. The existing literature must be reexamined in light of these issues.

Adolescent↗
PubMed1984

Emotional mood states and memory: elaborative encoding, semantic processing, and cognitive effort.

The effects of experimentally induced mood states on recall of target words embedded in sentences or alone were examined in three experiments. All experiments focused on the role of a depressed-mood induction on recall and looked at the effects of elaborative encoding, semantic processing, or cognitive effort. The overall effect of the depressed-mood state was to reduce recall in all three situations; however, the opportunity to process information semantically still led to superior recall in the depressed condition. In contrast, the superiority of recall of high-effort items disappeared in the depressed condition, suggesting that subjects may differentially allocate resources when under a depressed-mood state. The results are briefly discussed within the framework of a resource allocation theory.

Affect↗
PubMed2004

State perspective on ways to improve radiation protection principles.

State radiation regulators have a broad scope of regulatory authority. They are responsible for regulating both man-made and naturally occurring radioactive material, radiation-producing machines, and nonionizing sources of radiation. This broad-scope authority presents challenges to state radiation regulatory agencies that must implement and maintain a regulatory framework that incorporates radiation safety principles for all types of uses, without unduly hindering effective use of sources of radiation. The challenges include resource allocation, prioritization of risk in order to appropriately allocate resources, and the ability to effectively predict and respond to changing risk-informed priorities. Changes in radiation protection principles and policies must be accomplished through a partnership of stakeholders to be most effective and to meet these challenges.

Guidelines as Topic↗
PubMed2006

A reassessment of recall frequency intervals for screening in low caries incidence populations.

OBJECTIVES: To reassess the recall frequency interval for dental examinations for children, based on annual caries increments. METHODS: Cross sectional data collected on school children in eight rural and urban schools through the national Incremental Dental Care Programme (IDCP) for one district in Malaysia were analysed to assess their annual caries increment and trend lines. The Restorative Index was calculated to assess the success of the IDCP in rendering children dentally fit. RESULTS: The annual caries increments were low; the current caries levels were between 0.65 and 1.50 for 12 year-old children in Kota Tinggi District. Most of the caries experience was on pits and fissures. From 7 to 12 years old, the overall annual caries increment for the total study population was 0.19. The mean annual caries increment increased slightly between the ages of 12 to 14 years and 14 to 16 years and was 0.24 and 0.25 respectively. Two distinct caries incremental trend lines were observed for children aged 7 to 16 years. One group reached a mean DMFT of about 0.75 while the other group a mean DMFT of about 1.4 at 12 years. The trend lines continued over the next 4 years until the children were 16 years old. The Restorative Index was higher in urban schools that also had low DMFT levels. CONCLUSIONS: Based on the low annual caries increments of between 0.65 and 1.50, yearly dental examination intervals can safely be extended to 2-yearly intervals or even longer. Such a change of screening recall intervals would help improve resource allocation. Resources saved by extending recall intervals can be redirected to the small proportion of children with higher disease levels. This will help render more school children dentally fit and reduce inequalities in oral health.

Adolescent↗
PubMed1995

Census based deprivation indices: their weighting and validation.

KEY ISSUES--Over one hundred years of social science research has shown that different social groups have different probabilities of suffering from multiple deprivation; yet census based deprivation indices frequently assign equal weightings to each of their component variables. This becomes highly problematic when these indices are used as the basis for allocating resources to local and health authorities. In order to ensure fairness and accuracy in resource allocation these indices should be both weighted and validated. STUDY RESULTS--Weightings are derived from the Breadline Britain in the 1990s survey to produce a census based deprivation index that estimates the percentage of poor households at electoral ward level. Examples of validation methodology are discussed and the estimate of the proportion of poor households is shown to be highly correlated with both low income and morbidity as estimated from the 1991 census. DATA SOURCES--The 1991 census local base statistics (LBS) and small area statistics (SAS) aggregated for the 8519 electoral wards of England. The Breadline Britain in the 1990s survey: a nationally representative survey of 1831 households specifically designed to measure poverty and multiple deprivation.

Data Collection↗
PubMed1999

Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity.

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developing foot ulcers, which can lead to lower extremity amputation. Within the population of diabetic patients, it is widely accepted that patients with neuropathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current emphasis in care of the foot of a diabetic patient involves a multidisciplinary team approach combining patient education, skin and nail care, and accommodative shoe wear. As data from prophylactic programs become available, resource allocation and cost of care can be compared with this benchmark baseline. This benchmark analysis can be used by those who are responsible for allocating resources and projecting healthcare costs for this "high utilization"/high risk patient population.

Ankle Joint↗
PubMed1992

Administrative ethics in the 1990s: CEOs confront payment, access dilemmas.

The 1990s are presenting new challenges to hospital CEOs. One theme currently emerging is the ethics of resource allocation. As they search for ways to fulfill their community responsibilities under pressures related to reimbursement, technology and community desires, hospitals are finding that they must make some very tough choices in how they allocate resources. Given the opportunity, how would you respond? Compare your response to an ethical scenario with those of three nationally recognized hospital CEOs.

Attitude of Health Personnel↗
PubMed1977

Health care cost-containment regulation: prospects and an alternative.

Regulation of the health care system to achieve appropriate containment of overall costs is characterized by Professor Havighurst as requiring public officials to engage, directly or indirectly, in the rationing of medical services. This rationing function is seen by the author as peculiarly difficult for political institutions to perform, given the public's expectations and the symbolic importance of health care. An effort on the part of regulators to shift the rationing burden to providers is detected, as is a trend toward increasingly arbitrary regulation, designed to minimize regulators' confrontations with sensitive issues. Irrationality and ignorance are found to plague regulatory decision making on health-related issues, even though it is the consumer who is usually thought to suffer most from these disabilities. The author argues that consumer choice under some cost constraints is a preferable mechanism for allocating resources because it better reflects individuals' subjective preferences, has a greater capacity for facing trade-offs realistically, and can better contend with professional dominance of the resource allocation process. In view of the unlikelihood of regulation that is both sensitive and effective in containing costs, the author proposes that we rely primarily on consumer incentives to reform the system. A simple change in the tax treatment of health insurance or other health plan premiums, to strengthen consumers' interest in cost containment while also subsidizing needy consumers, is advocated. Steps to improve opportunities for innovation in cost containment by health insurers, HMOs, and other actors are outlined briefly.

Choice Behavior↗