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At least 667 records · Page 37Linked to original sources
PubMed2002

Medical decision criteria and policy for an efficient allocation of resources.

This paper approaches health care criteria by maximizing society's consumption possibilities in a model where health is a special case of a good produced, consumed, and used as an input in production, and the patient chooses from alternative therapies. It complements the conventional approach, in providing conditions under which it is optimal to provide care beyond the public health standard. It is shown to be optimal to provide health care beyond the previously obtained optimum where the marginal product generated by the care equals its marginal social cost, up to the point where the sum of the marginal product and the marginal utility equals that cost--but only if the patient is willing to pay the full marginal social cost of the part that exceeds the marginal product, out of his after-tax income, the part corresponding to the marginal product being deductible from taxable income. For the decision, the social planner needs to know the costs of different therapies and the times they take to bring the patient to working condition, as well as the patient's labor income in this condition, but not the patient's preferences. The higher the patient's labor income, the more it is optimal to spend on more efficient therapy, and provide a "tax subsidy" by keeping the expenses for the investment part tax-deductible. An increase in hospital capacity leads to treating patients with cases medically minor to those treated before, incomes equal, if rationing is done optimally so that this finding is not necessarily a sign of demand-shifting.

Decision Making↗
PubMed1993

Risky decision making and allocation of resources for leukemia and AIDS programs.

Traditional judgment and decision-making paradigms were expanded to include differential reactions to persons with leukemia or AIDS. Experiments 1 and 2 adopted Tversky and Kahneman's risky-decision-making task and found support for different value functions for the 2 patient groups when choosing between treatment programs. From these results, the subjective value of saving a fixed number of lives appears to be greater for persons with leukemia than for persons with AIDS. Experiment 3 provided additional data concerning differential perceptions of the causes of AIDS. This proved to be a useful means of classifying Ss who did and did not devalue the lives of persons with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The Master Settlement Agreement and African Americans: opinions about the allocation of resources.

This article analyzes demographic, attitudinal, and behavioral variables that predict African Americans' opinions about state distribution of funds received from the Master Settlement Agreement (MSA). The sample consisted of 1,000 randomly selected African Americans from 10 U.S. congressional districts represented by African Americans. Descriptive analysis revealed that 38.7% of respondents favored dispersing funds evenly between tobacco control and other state functions, and 63% of respondents favored specifically directing MSA funds to African American communities. Cumulative logit regression analysis showed that age, education, geographic region, and smoking status were significant predictors of opinions about spending MSA funding on antismoking initiatives. Multiple logistic regression analysis revealed that opinions about targeted MSA funds to African Americans varied by homeownership, views on tobacco excise taxes, the fairness of tobacco taxes to African Americans, and the association between smoking and racism in U.S. society.

Adolescent↗
PubMed1994

Allocation of resources at the bedside: the intersections of economics, law, and ethics.

In the preceding article, Mehlman and Massey examine possible legal responses to the issues that confront physicians faced with treating patients who have insufficient financial resources. This commentary explores the same issues from the perspective of ethics, including a comparison of the way law and ethics interpret the physician-patient relationship, the ethical obligations of physicians that are inherent in that relationship, and the propriety of Mehlman and Massey's legal and ethical proposals to ameliorate physicians' conflicting obligations in providing or withholding care on grounds of conservation of society's resources.

Beneficence↗
PubMed2004

[The necessary frugality of the elderly].

The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the allocation of public resources for health on the age variable, considered from the perspective of the theory of "justice as equity" as formulated by John Rawls. After characterizing the problem of public resource allocation for health -- confronted with the challenge posed by population aging -- and briefly presenting the concept of equity adopted in this study, as well as discussing the approach by Norman Daniels and Daniel Callahan to resource allocation among different age groups, we conclude that basing resource allocation on the age variable may be considered ethically adequate if we conceive the individual's life as a limited cycle of existence formed by different stages (childhood, adolescence, maturity, old age, and death), during which the needs vary, such that the distribution of resources among different age groups should be based on an ethics of protection.

Age Factors↗
PubMed2000

Using social indicators to inform community drug and alcohol prevention policy.

In recent years, the federal government has begun to require state agencies to allocate drug prevention resources according to the needs of local communities. The methods by which this is to be accomplished have not been described, and most published social indicator studies in the field of drug abuse research have used county-level data which are too insensitive to local needs to be of use in resource allocation decisions. The present study describes a needs assessment in drug abuse prevention in the state of New Jersey using municipal-level social indicator data. In addition, it examines the extent to which the resource allocation of one state prevention agency can be predicted by the municipal-level social indicators. Thirty-six social indicators pertaining to 508 municipalities were used in the study, and data were analyzed using principal component analysis and hierarchical regression analysis. Five factors were extracted from the principal component analysis, two of which clearly describe "high risk" municipalities and one of which clearly describes "low risk" municipalities. The regression analysis showed that these factors explained very little of the variance in the state agency's drug prevention spending. The study shows that social indicators can be used to distinguish between different levels of need for drug prevention services at a municipal level, and that these data can be used to inform decisions concerning resource allocation.

Alcoholism↗
PubMedDate not supplied

Optimal allocation of resources across four interventions for type 2 diabetes.

BACKGROUND: Several interventions can be applied to prevent complications of type 2 diabetes. This article examines the optimal allocation of resources across 4 interventions to treat patients newly diagnosed with type 2 diabetes. The interventions are intensive glycemic control, intensified hypertension control, cholesterol reduction, and smoking cessation. METHODS: A linear programming model was designed to select sets of interventions to maximize quality-adjusted life years (QALYs), subject to varied budget and equity constraints. RESULTS: For no additional cost, approximately 211,000 QALYs can be gained over the lifetimes of all persons newly diagnosed with diabetes by implementing interventions rather than standard care. With increased availability of funds, additional health benefits can be gained but with diminishing marginal returns. The impact of equity constraints is extensive compared to the solution with the same intervention costs and no equity constraint. Under the conditions modeled, intensified hypertension control and smoking cessation interventions were provided most often, and intensive glycemic control and cholesterol reduction interventions were provided less often. CONCLUSIONS: A resource allocation model identifies trade-offs involved when imposing budget and equity constraints on care for individuals with newly diagnosed diabetes.

Adult↗
PubMed2004

Does earmarked donor funding make it more or less likely that developing countries will allocate their resources towards programmes that yield the greatest health benefits?

It should not be assumed that earmarked donor funding automatically increases the allocation of developing-country resources towards programmes that yield the greatest health benefits. Sometimes it does, sometimes it does not--how the funding is designed can influence this. This is true particularly in the longer term, once the earmarked funding has ended. Even in the short term, total funding does not necessarily increase because of fungibility (i.e. recipient governments adjust their spending to offset donor funding preferences). The author explores six problems with earmarked funding: the multiplicity of earmarked funds confuses the situation for decision-makers; earmarking works against the spirit of the sectorwide approach; from the national perspective, it makes sense not to double-fund activities; local ownership of an activity is often compromised; earmarking can lead governments to accept interventions which they cannot afford in the longer term; and earmarking can distort local resource allocation.

Developing Countries↗