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At least 685 records · Page 38Linked to original sources
PubMed2004

Allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia: based on cost effectiveness and the social welfare function.

OBJECTIVE: To use the social welfare function to decide on allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia for the primary prevention of coronary heart disease. METHOD: Three smoking cessation therapies (medical advice, nicotine gum and nicotine patch) were considered in smokers, and lovastatin 20, 40 and 80 mg/day was considered in individuals with hypercholesterolaemia (total cholesterol > 7.24 mmol/L [> 270 mg/dL]). Multiple logistic regression analysis was used to obtain parameter epsilon determining the exact form of the social welfare function in Catalonia, Spain. The preferable strategy was to give higher priority to the intervention that used one smoking cessation method and lovastatin treatment for hypercholesterolaemia and that was associated with a value of epsilon consistent with the social welfare function. RESULTS: A value of 1.58 (95% CI: 0.75-2.84) was obtained for parameter epsilon of the social welfare function, showing a nonutilitarian form. A higher priority should be given, based on the social welfare function, to the intervention using medical advice for smoking cessation and lovastatin 20-80 mg/day for hypercholesterolaemia, since this approach was associated with epsilon values of 2.8-2.9 in men and 1.8-2.4 in women, while interventions using nicotine substitution therapies were associated with epsilon values of < 0.9 in men and < 0.4 in women. The cost of treating all smokers and individuals with hypercholesterolaemia was 35% lower using medical advice for smoking cessation and lovastatin 20 mg/day, which was associated with epsilon values of 2.9 in men and 2.4 in women, than using a utilitarian solution consisting of nicotine patches for smoking cessation and lovastatin 20 mg/day. CONCLUSION: These results show that higher priority should be given to lovastatin treatment of hypercholesterolaemia than to nicotine substitution treatments for smoking cessation, based on cost effectiveness and the social welfare function. The study also showed the applicability of this method to decisions about resource allocation between competing treatments when society has a nonutilitarian social welfare function.

Administration, Cutaneous↗
PubMed2004

Regionalization and the allocation of healthcare resources to meet population health needs.

This brief commentary examines why regionalization can improve the extent to which resources are allocated in line with need; highlights the challenges associated with the two stages of resource allocation within regionalized systems (allocation from the ministry to the regions and allocation within a region); and assesses the experience with needs-based funding in Canada under regionalized governance.

Canada↗
PubMed2003

The evolution of PBMA: towards a macro-level priority setting framework for health regions.

To date, relatively little work on priority setting has been carried out at a macro-level across major portfolios within integrated health care organizations. This paper describes a macro marginal analysis (MMA) process for setting priorities and allocating resources in health authorities, based on work carried out in a major urban health region in Alberta, Canada. MMA centers around an expert working group of managers and clinicians who are charged with identifying areas for resource re-allocation on an ongoing basis. Trade-offs between services are based on locally defined criteria and are informed by multiple inputs such as evidence from the literature and local expert opinion. The approach is put forth as a significant improvement on historical resource allocation patterns.

Alberta↗
PubMed1993

Attitudes of mothers, doctors, and nurses toward neonatal intensive care in a developing society.

BACKGROUND: The ethical allocation of scarce resources is a major challenge for physicians working in the developing world. Guidelines currently employed by health care workers in the developed world may be considered impractical or inappropriate in the "Third World." OBJECTIVE: To gain insight into the attitudes of doctors, nurses, and mothers of recent neonatal intensive care unit (NICU) survivors toward the utilization and withdrawal of life support in the context of a developing society. DESIGN: Descriptive cohort study. PARTICIPANTS: Thirty-three doctors, 20 nurses, and 70 mothers of recent NICU survivors. The cohort of mothers surveyed were predominantly unmarried, poorly educated, and either unemployed or still at school. RESULTS: In response to hypothetical scenarios, mothers exhibited very conservative attitudes toward withdrawal of life support compared to caregivers. Only 2.9% (2/70) of mothers would contemplate any degree of life support withdrawal for infants with probable "moderate" handicap compared with 51.0% (26/51) of the medical staff. One mother (1.4%, 1/70) accepted the concept of withdrawal of life support where extremely poor outcome was anticipated, compared with 85% (45/53) of the caregivers. Doctors and nurses exhibited very utilitarian attitudes toward NICU resource allocation, with emphasis directed toward avoidance of significant handicap. The majority of these caregivers considered the anticipated burden of the handicapped child in the society to be a major factor in the justification of their decision. CONCLUSION: The nonideal conditions under which doctors and nurses work in developing nations mandate resource allocation to be an integral component of NICU care.

Attitude of Health Personnel↗
PubMed1993

Cost-utility analysis.

Decisions have to be made about allocating health resources. Currently the best economic evaluation method for doing this is cost-utility analysis. This compares the costs of different procedures with their outcomes measured in "utility based" units--that is, units that relate to a person's level of wellbeing. The most commonly used unit is the quality adjusted life year (QALY). QALYs are calculated by estimating the total life years gained from a procedure and weighting each year to reflect the quality of life in that year. To compare outcomes of different programmes the Rosser index is one measure that is widely used to assign quality of life scores to patients. Combined with a measure of life years gained from a procedure, this enables QALYs to be calculated and procedures ranked according to cost per QALY gained. In this article Ray Robinson explains the measures used and discusses how QALY league tables can be used to guide decisions on resource allocation.

Adult↗
PubMed1994

Preventing child pedestrian injury: pedestrian education or traffic calming?

The traditional approach to the prevention of child pedestrian injuries in New Zealand is pedestrian education. However, none of the programs currently being implemented in New Zealand have ever been shown to reduce injury rates. The allocation of scarce resources to pedestrian education must therefore be questioned. In this paper we estimate the number of serious child pedestrian injuries which might be prevented if the resources allocated to pedestrian education were allocated instead to environmental approaches, in particular, to traffic calming. It is estimated that approximately 18 hospitalisations of child pedestrians could be prevented each year under this alternative resource allocation, disregarding any other benefits of traffic calming. These results emphasise the need to consider the potential sacrifices involved in the allocation of scarce resources to child pedestrian education.

Accidents, Traffic↗
PubMed1996

Rationing: a transatlantic perspective.

Despite the differing mechanisms of health care delivery and financing in the United Kingdom and the United States many of the issues faced by the two countries are similar, most notably the increasing financial pressures. In both countries there have been recent changes in the allocation of resources and the mechanisms of decision making. Different criteria for determining resource allocation have been tried in the two health care systems. These developments change long traditions of rationing decisions at the individual patient level in the US, and of centralised government decision making in the UK.

Health Care Rationing↗
PubMedDate not supplied

Are preferences for equality a matter of perspective?

BACKGROUND: Many subjects attach equal value to different health care programs in surveys eliciting preferences for resource allocation. It has been suggested that subjects may be prepared to attach different priority if they were asked to evaluate someone else's decision instead of adopting the role of a social decision maker. This study investigated whether the perspective individuals are asked to adopt affects their priority setting decisions and the likelihood of assigning equal value to health care programs. METHODS: 1253 members of an Internet panel were presented a set of clinical vignettes describing preventive health care initiatives and were asked to prioritize among these. They choose between "discrimination," that is, allocating all resources on the better program, and "equality," that is, dividing the resources equally between programs while reducing efficiency. Respondents were randomized to either of 4 survey versions that differed in terms of perspective (evaluator vs. decision maker) and expert status (expert vs. layperson) of the role to be adopted. RESULTS: Subjects in the evaluator perspectives were more likely to choose equality over discrimination between patients as compared to those in the social decision-maker perspectives, regardless of expert status (odds ratios 2.09 and 2.03, P<0.0001). Excess rates of equality choices in the evaluator frames resulted from passive acceptance of equality decisions and active revision of prioritization decisions. CONCLUSION: Preferences for an equal allocation of resources are strongly affected by decision-making perspective but stable across expert status of the adopted role.

Adult↗
PubMed2003

Decision aid for allocation of transportation funds to guardrails.

We address the need for allocation of resources to run-off-road and fixed-object hazards on immense secondary road systems. In Virginia, there are 95,000km of roadway with uncharacterized hazards in need of guardrail upgrade, installation, or related warning signs or other protection. A decision aid is developed to assist the planner in guardrail resource allocation by accounting for the potential crash severities, traffic exposures, costs of treatment, and other factors. A premise is that no single benefit-cost ratio or selection criterion applies across all localities. The decision aid enables the planner to interpret the variety of benefits and costs in their own units, emphasizing the needs and preferences of individual localities. The paper describes: (1) archiving and comparison of protected and unprotected hazards; (2) regional screening of hazardous corridors and (3) multicriteria benefit-cost analyses of guardrail sites. A case study of guardrail selection is presented.

Accidents, Traffic↗
PubMed2003

Funding fertility: issues in the allocation and distribution of resources to assisted reproduction technologies.

The appropriate level and source of funds for assisted reproduction technologies (ARTs), in particular IVF, have been controversial in most developed economies. Funding of fertility services internationally is characterized by low public (or other third party) funding, a greater reliance on user-pays than in most other health services, and variations in funding and provision. This article describes the characteristics of infertility as a condition and its treatment that have been used as a rationale for its exclusion from an otherwise comprehensive coverage of health services. The challenges these characteristics pose for the use of economic evaluation to inform resource allocation are discussed. Most economic evaluations have focused on the cost effectiveness of alternative infertility treatments. These evaluations provide important information, but do not inform the real issue at stake: what is the appropriate allocation of funds to ARTs, given that it involves sacrificing improvements in health in other areas? Cost utility analysis - the method of economic appraisal preferred by most agencies charged with making such decisions (including the National Institute of Clinical Excellence in the UK) - is ill-equipped to deal with the benefits produced by ARTs. Alternative methods are available, but require decision makers to weigh up very different sorts of evidence. Demonstration of the willingness to pay for the benefits of ARTs can be used to support public decisions but, conversely, also implies that those who can pay will pay in a private market. Ultimately, decisions about the inclusion or otherwise of ARTs in collectively funded health systems probably rest as much on judgments about equity in access as value for money. Given that this is the case, public funding of IVF should be accompanied by the development of agreed criteria for the prioritization of potential recipients, to ensure treatment is targeted at those for whom it is most effective and that access is consistent and fair.

Adult↗
PubMed2000

Equity in the allocation of health care resources.

This paper examines some of the issues that arise when seeking to tackle health inequalities in a context of limited health care resources. Increasingly, central agencies are using devolved budgets for health care providers as a central instrument of expenditure control. Equity objectives play an important role in the resource allocation methods used to determine such budgets. Yet, unless integrated into a proper system of risk management, the use of budgets can lead to serious inequity. The paper discusses the potential contributions of different disciplines to promoting equity within a health care budgetary regime.

Budgets↗
PubMed2006

Fair rationing is essentially local: an argument for postcode prescribing.

In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be "local" in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS.

Community Medicine↗
PubMed1999

Allocative efficiency in the use of health resources in Portugal.

BACKGROUND: This is the first time that a resource allocation technique based on a marginal met need approach has been used in Portugal, and the objective of the study is to attain the improvement of allocative efficiency. METHODS: The utilities of health states with and without treatment have been measured using the rating scale technique and a cost-utility analysis has been made. The value resulting from multiplying the avoided days of incapacity by a weight, on a scale from zero to one, has been considered as an indicator of utility corresponding to the difference between a health state with and without treatment. This study has been carried out using the main causes of morbidity from the National Health Survey, 1987, at a regional level. A sample of 150 local authorities was considered to be sufficient. A second objective of this study was to carry out a cost-utility analysis for the main causes of declared morbidity. RESULTS: This analysis has shown that the ratio of cost-utility is highest for hypertension, followed by influenza, asthma and digestive ill-functioning. Pharyngitis-amygdalitis, cold, osteoarthrosis, chronic bronchitis, spondylous arthrosis and diabetes are the illnesses with a more favourable cost-utility ratio which, in a rational resource allocation, should be treated first. CONCLUSIONS: So that an increase in the allocative efficiency could be achieved, a transfer of resources between regions is required up to the point at which the use of these resources would be equally efficient. Resources should be transferred from two regions - Interior Centre Region and Littoral Lisbon Region - towards all the other regions, in particular the Interior North Region.

Adult↗
PubMed1992

Rationality and the use of formulae in the allocation of resources to health care.

The paper describes how the apparent move towards rationality in allocating resources in the National Health Service using statistically based formulae is illusory. This is not just a technical problem of poor application of statistical techniques. The basic problem is to find a combination of factors reflecting dimensions of need and then appropriate weights with which to combine them within the context of the guiding principles of equity and efficiency. The paper explains how there has been little consistency in measuring need and how statistical methods have often masked the lack of appropriate data and models. Alternative approaches to measuring need within a policy context are discussed and a research agenda is outlined which, rather than concentrating on evermore complex statistical techniques, focuses on the necessity for more validly operationalizing 'needs' and their resource implications.

Health Resources↗
PubMed2001

Resource allocation-based life histories: a conceptual basis for studies of ecological toxicology.

Whereas ecological assessments of contaminants are concerned with populations and higher levels of organization, most mechanistic work in toxicology is directed at effects on individuals and their parts. We propose that studies based on individuals can be useful in ecological analysis of polluted systems when based on the concepts of resource allocation-based life history analysis. At the heart of the resource allocation approach is the concept of operative environments of individuals (i.e., environmental factors influencing birth, death, or migration). Contaminants can have strong influences on operative environments, modifying resource allocation strategies that reflect changes in energy assimilation and demands. By examining contaminant-induced responses of individuals from the perspective of changing operative environments, individual-based changes and population dynamics can be addressed in an ecologically rigorous manner.

Animals↗
PubMedDate not supplied

Patient flow based allocation of hospital resources.

The current practice of allocating resources within a hospital introduces peaks and troughs in the workloads of departments and leads therefore to loss of capacity. This happens when requirements for capacity coordination are not adequately taken into account in the decision making process of allocating resources to specialties. The first part of this research involved an analysis of the hospital's production system on dependencies between resources, resulting in a number of capacity coordination requirements that need to be fulfilled for optimized resource utilization. The second, modelling, part of the study involved the development of a framework for resource management decision making, of a set of computer models to support hospital managerial decision making on resource allocation issues in various parts of the hospital, and of an implementation strategy for the application of the models to concrete hospital settings. The third part of the study was devoted to a number of case-studies, illustrating the use of the models when applied in various resource management projects, such as a reorganization of an operating theatre timetable, or the development of a master plan for activities of a group of general surgeons serving two locations of a merged hospital system. The paper summarizes the main findings of the study and concludes with a discussion of results obtained with the new allocation procedure and with recommendations for future research.

Bed Occupancy↗
PubMed2002

Distributive justice and the introduction of generic medicines.

INTRODUCTION: All countries face the issue of choice in healthcare. Allocation of healthcare resources is clearly associated with the concept of distributive justice and to the existence of a right to healthcare. Nevertheless, there is still the question of whether this right should include all types of healthcare services or if it should be limited to selected types. It follows that choices must be made, priorities must be set and that efficiency of healthcare services should be maximum. OBJECTIVES AND METHODS: Distributive justice aims at ensuring that everyone has access to necessary care based on the substantive ethical principles of equity and solidarity. Resource allocation is paramount in public policy particularly with regards pharmacoeconomics. The objective of this study is to determine the leading issues regarding the marketing and trade of generic medicines analysing the reasons why there are huge disparities between European countries with regards generic drugs acceptance by practitioners. RESULTS AND CONCLUSION: Distributive justice aims at ensuring that everyone has access to reasonable care based on the ethical principles of equity and solidarity. However, universality implies always choice in access and efficiency in delivery. It follows that resource allocation is instrumental in public policy particularly with regards pharmacoeconomics. The acceptance of distributive justice as a new ethical paradigm for professional ethics implies that as long as the best interest of the patient is not at stake physicians should regard the use of generic drugs as a valid instrument to promote the efficiency of the system and therefore as a way to facilitate citizen's global access to healthcare.

Drugs, Generic↗
PubMedDate not supplied

[Economic evaluation of the demand of medical care for mental health in Mexico: schizophrenia and depression, 1996-2000].

Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations and those for uninsured populations, with a greater economic impact on-the former. Independent from differences found, these results allow the identification of economic evaluation indicators that could be used to design resource allocation schemes for each of the institutions included in this study.

Depression↗