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At least 721 records · Page 40Linked to original sources
PubMed1998

The growing importance of cost-effectiveness in oncologic practice.

In an era of increasing cost containment in health care, it has become extremely important to allocate resources as efficiently as possible. This implies that formal health economic considerations are taken into account. One area of increasing importance is the field of economic appraisal, which allows the monetary value of medical interventions to be quantified. This type of research is extremely useful in the field of supportive care of cancer patients. In addition to economic considerations, social, political, and ethical issues must also be addressed. Finally, the sum of these activities will enable us to make better choices in health care, and ensure that sufficient resources are allocated to supportive cancer treatment.

Cost-Benefit Analysis↗
PubMed1992

Futility: not just a medical issue.

We do not like the idea of doctors and nurses being forced to provide care that offends their sense of themselves and their art. But we like even less the idea of physicians allocating resources without the force of society's judgment. Physicians must help craft the policies on futility or those policies will not reflect sound medical judgment. But how our country creates policies is as important as what the policies mandate. If our society requires physicians to create health care policies on their own, we will shirk our responsibility to ourselves.

Decision Making↗
PubMed2002

From flying doctor to virtual doctor: an economic perspective on Australia's telemedicine experience.

Current funding mechanisms can impede the efficient use and integration of telemedicine services. Telemedicine has developed in Australia against a background of complex funding arrangements and interwoven health-care responsibilities. These impediments are not unique to telemedicine but are accentuated by its ability to cover different locations, clinical areas and purposes. There is also a link between economic evaluation and funding mechanisms for telemedicine. While economic evaluations provide important information for the efficient allocation of resources, the funding environment in which telemedicine is established is also crucial in ensuring that services are efficient. Given these complexities, should telemedicine be funded? We conclude that this will depend on: the objectives and priorities of the health system; the efficiency of telemedicine relative to that of other forms of health-care delivery; and the funding environment. In terms of resource allocation processes, the optimum scenario is likely to be where the decision to invest in telemedicine services is made taking local needs into account, but where considerations such as market structure and network compatibility are examined on a broader scale and balanced against the principles of efficiency and equity.

Australia↗
PubMed1997

Should health insurance cover IVF? Issues and options.

An emotional debate has attended the question of whether health insurance should cover the cost of in vitro fertilization (IVF) for infertile couples. Some private health plans have opted to cover IVF, although most have not. Ten states have mandated that it be included or offered as a standard benefit for private health insurance plans. This article analyzes several key issues in the debate: the impact of insurance coverage; the cost-effectiveness of IVF; valuing the benefit of IVF; and adoption as an alternative. It recommends policy action in several areas: more efficiently allocating resources for IVF (by giving priority to couples with better chances of success, and by making more extensive use of facilities with higher success rates); ensuring that clear and reliable information about the effectiveness of IVF is available; and leveling the playing field between IVF and adoption.

Adoption↗
PubMed2003

Tools of the trade: a comparative analysis of approaches to priority setting in healthcare.

In many countries, local managers and clinicians have been given responsibility to set health priorities and allocate resources accordingly. Although tools have been suggested for use in aiding this process, knowledge of these tools within health regions is lacking and comparative analysis in the literature is limited. Several approaches to priority setting are critiqued from both practical and theoretical perspectives, and a tangible way forward for such activity is provided. The approaches analysed include: needs assessment, core services, economic evaluation including quality-adjusted life year league tables, and programme budgeting and marginal analysis (PBMA). Needs assessment fails to recognize underlying economic principles of opportunity cost and the margin, while core services ignores the margin and has had limited impact in practice. Economic evaluations can consider marginal costs and benefits, but cannot always be used to inform decisions in a timely manner. PBMA is based on underlying economic principles and can pragmatically respond to objectives related to both efficiency and equity. Although PBMA is not without challenges, from an economic perspective, it does seem to "get the thinking right", and, importantly, as a process, can incorporate some of the other approaches to priority setting discussed in this paper.

Budgets↗
PubMed1998

Risk assessment and economic analysis for managing risks to human health from pathogenic microorganisms in the food supply.

Risk managers increasingly face having to justify their decisions in allocating limited resources. These decisions may include prioritizing hazards, determining appropriate levels of safety, and identifying and selecting optimal risk reduction strategies. These decisions require making choices among alternatives, choices that may be difficult because they invariably involve trade-offs. Integrating risk assessment and economic analyses can aid decision making by determining the benefits and costs of alternative actions. Risk assessment and economic analysis provide the measurement tools that will facilitate intelligent, informed, risk management and will enable effective and efficient resource allocation decisions.

Costs and Cost Analysis↗
PubMed1990

Withdrawing and withholding treatment in intensive care. Part 2. Patient assessment.

In order to allocate resources fairly in intensive care units, and to avoid treatment which only prolongs dying, accurate prediction of outcome is necessary. Most systems that have been developed to predict the outcome of treatment are flawed and are little better than the guesses of experienced medical and nursing staff. The likelihood of survival must then be weighed against a subjective assessment of quality of life. The perception that intensive care wastes resources on patients who have little chance of survival should be reassessed in the light of our limited ability to detect hopelessly ill patients before embarking upon treatment.

Australia↗
PubMed1991

Intensive care units in the triage mode: an organizational perspective.

Decisions to admit and discharge patients to and from the intensive care unit (ICU) when beds are scarce should be made in accordance with the triage principle--that is, allocate resources on the basis of the ability to benefit from intensive care. However, uncertainty over resource capacity and patient prognosis limits the ability of decision makers to use this prioritization principle and results in ICUs containing inappropriately placed patients who are denying or delaying care to patients who could benefit more. Using Jay Galbraith's "information processing" model, ICU admission and discharge decision making is described. Organizational strategies to reduce uncertainty and improve decision making are discussed, including strengthening the management role of the ICU physician director and employing prognostic instruments (e.g., mortality prediction models) to share and process information.

Decision Making↗
PubMedDate not supplied

Using healthy life years (HeaLYs) to assess programming needs in a public health unit.

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Adult↗
PubMed1993

A 1993 Status Report on the Health Status of Asian Pacific Islander Americans: Comparisons with Healthy People 2000 Objectives.

PURPOSE OF THE PAPER: The purpose of this paper is to offer a current assessment of the health status of Asian Pacific Islander Americans (APIAs) with respect to relevant Healthy People 2000 objectives and an assessment of Federal resource allocations targeted at APIAs. SUMMARY OF METHODS UTILIZED: The author reviewed documents from the relevant progress reports made to the Assistant Secretary on Health on Healthy People 2000 objectives, other Federal documents, and a review of the literature. PRINCIPAL FINDINGS: Adequate progress has been made on only one of the eight objectives targeted at APIAs; progress on the remaining objectives is either "not on target," require more data to evaluate, or inappropriate for APIAs at this time. Examples of APIA health problems not included in Healthy People 2000 objectives were documented. Illustrations of inadequate allocations of Federal health resources were cited. CONCLUSIONS: APIAs have been among the most neglected minority group with regards to health status surveillance, health services, and have been the most overlooked in Federal resource allocations. However, as greater awareness of data deficits and health status is presented, policy makers have the opportunity to improve the situation. A policy to improve the health status of APIAs must be multifaceted and minimally include the facets of data needs, intervention approaches, a research agenda, and advocacy. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: A 1993 review of the health status of APIAs with regards to the eight Healthy People 2000 and areas not covered by Healthy People 2000 were reviewed. KEY WORDS: Asian Americans, health status, health policy, health planning, tobacco, diet, diseases

Journal Article↗
PubMed1998

The tragedy of the census.

The author discusses the debate on how to reduce the undercount error in the 2000 U.S. census. He reviews the history of the census, and considers the impact of the "opposing ¿interest groups' represented in Congress and elsewhere debating methodological issues that can affect the distribution of census-allocated resources [who] tend to favor methodological choices that will increase their resources."

Americas↗
PubMed2005

Ethical principles and the rationing of health care: a qualitative study in general practice.

BACKGROUND: Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. AIM: To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. DESIGN OF STUDY: A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. SETTING: Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. METHOD: Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. RESULTS: With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. CONCLUSION: The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice.

Adult↗
PubMed2006

Year 2006 update of the Israel National List of Health Services.

In Israel, updating of the National List of Health Services is performed on a yearly basis by means of a systematic and structured mechanism for almost a decade. The existence of such a mechanism is vital for keeping medicine up to date, since many innovative and breakthrough medical technologies continuously and frequently evolve. The 2006 update is unique in several aspects, relating both to the mechanism and to the decision-making process. In this article we describe notable issues that arose during the current process: modifications to the update mechanism, the four-phase increase in allocated resources to fund the addition of new medical technologies (including the addition of finances at the expense of the 2007 planned budget), and public funding for high-cost therapies. Finally, we discuss the impact of medical advances on healthcare costs and a suggested constant annual addition to the budget.

Biomedical Technology↗
PubMedDate not supplied

[How to reduce health inequalities between regions?].

The article addresses the question how public decision makers can manage, through resources allocations, to reduce health inequalities between regions. After a description of the British experience, the author suggests a simplified method for determining the gap between the effective allocation of resources and that which would be optimal. Application to France is proposed.

England↗
PubMed1988

Bone marrow transplantation: economic, ethical, and social issues.

Bone marrow transplantation is a useful model for the controversies surrounding medical technologies that involve high cost, mortality, and complications. This essay first delineates the economic circumstances of bone marrow transplantation, comparing it with other organ transplantations. Although children represent a significant proportion of bone marrow transplantation patients, little research has focused on the economic impact for this population. Next, the financial, social, and ethical motivations and controversies that surround bone marrow transplantation are explored, along with current allocation mechanisms. Finally, recommendations are offered for guiding discussions regarding the appropriate use of bone marrow transplantation. In making transplantation decisions, physicians must consider the costs and benefits of bone marrow transplantation for each patient. Such analyses, whether based on medical or socioeconomic criteria, are insufficient to resolve the fundamental cultural dilemmas posed by this procedure and other expensive medical technologies, however. The goal is to foster broader discussion of these issues to achieve more candid decisions in allocating resources among competing health priorities.

Aborted Fetus↗
PubMed1980

Regional neonatal transport: impact of an integrated community/center system.

In the face of increasing neonatal referrals from a large geographic region, community hospital resources was recruited and coordinated with regional center resources to facilitate "community-based" neonatal transport. All transport requests were first "triaged" by an attending neonatologist. Discriminant analysis was used to assess the impact of resource allocation decisions. Decisions regarding allocation of resources to an individual transport generally reflected geographic distance to be traveled, size of delivery service at referring hospital, and apparent degree of illness. Physicians participation in transports was reduced from 95% to 15% of the trips. The incorporation of community-based transport resources and nonphysician transport teams into a coordinated triage and transport process with existing center-based resources did not adversely affect neonatal survival. Capacity of the transport system was enhanced with these reallocations.

Alabama↗
PubMedDate not supplied

[Resident Assessment Instrument (RAI): a system for client evaluation and documentation in long-term care--an overview].

This article describes the interdisciplinary care planning system "Resident Assessment Instrument" (RAI) for nursing homes with its parts, the Health Care Financing Administration mandated "Minimum Data Set" (MDS) and the "Resident Assessment Protocols" (RAPs). The MDS-derived case mix system for resource allocation, the Resource Utilization Groups (RUGs), are mentioned. The prerequisites for an implementation of the F.R.G. are discussed.

Aged↗
PubMed1993

Balancing complex choices. Integrating strategic, financial plans will test tomorrow's health networks.

Juggling capital needs and resource allocation is a formidable task for any health care executive. But what lies ahead poses an even greater challenge: achieving strategic integration in multiprovider health networks. The complexity of determining how best to allocate financial resources while addressing the competing requests of network members is the foremost reason why experts say that common ownership is critical to the operational and financial success of provider networks.

Centralized Hospital Services↗