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At least 793 records · Page 44Linked to original sources
PubMed2005

Barriers to the equitable funding of primary healthcare in South Africa.

Over 25 years after Alma-Ata, available evidence suggests that in low- and middle-income countries (LMIC) the funding and coverage of primary care is still inequitable. This article reviews the progress that has been made towards the equitable funding of primary healthcare (PHC) in South Africa and evaluates barriers to future progress. The South African experience is assessed to consider implications for other LMIC. The results show that substantial inequities in funding persist (albeit using a narrow definition of PHC). Underlying causes relate to fiscal austerity, the lack of protection of PHC funding, incremental resource allocation and the belief that poorer districts are not able to use extra funds effectively. These results match the experience in other LMIC. Central governments have a critical role to play in lobbying for and protecting resources for PHC, maintaining more control over decentralised resource allocation and building capacity to benefit in poorer areas.

Financing, Government↗
PubMed1995

Help or hindrance? The role of economics in rationing health care.

The economic evaluation of alternative diagnostic and therapeutic interventions is not merely a help to the processes by which decision makers allocate scarce economic resources, it is an essential ingredient into those rationing processes. Clinicians and other decision makers who advocate the use of effectiveness data alone to determine who will be treated and who will be left in pain and discomfort may perpetuate the inefficient use of resources. Rationing, or resource allocation, in health care must be informed by knowledge of the costs and consequences (effects) or alternative interventions. To ignore the economic element in clinical choices, generates inefficiency, and therefore unethical practice. The great advantage of the economic approach to rationing is that it requires an explicit framework which identifies the costs and benefits of alternative actions in all domains of human action. The combination of explicitness and precision inherent in good economic evaluation can only help in the difficult task of producing further health benefits for patients from the limited resources of the NHS.

Health Care Rationing↗
PubMed1996

Where do internal markets come from and can they work?

The basis for the argument in favour of the internal market as a means of allocating resources within the health care sector has never been made fully explicit. In particular, the link between the economic theory of market allocation and the specific pricing rules adopted by a number of health care sectors to allocate resources is rarely a focus of attention. Health sector objectives are rarely specified. The mechanisms which remedy failure in the exchange process are not explicitly defined. In short, the optimal structural conditions for the operation of internal markets are not known. The central argument pursued here is that, as this is the case, and using the UK as an example, there are no criteria to which purchasers or providers can turn to assess the operation of exchange within the internal market. Not surprisingly, the internal market dissolves into a number of individual bilateral agreements between purchasers and providers which may or may not increase efficiency in allocating health sector resources.

Economic Competition↗
PubMed2005

[The regional budget for mental health care: a new approach to combine inpatient and outpatient care].

OBJECTIVE: Due to increasing health care expenditures the discussion about advantages and disadvantages of new methods for resource allocation in mental health care has been intensified. A promising model is the Regional Budget for Mental Health Care, which is currently being examined in Schleswig-Holstein. The present paper describes first experiences with the new resource allocation model. BASIC CONDITIONS: An annual budget, provided for the treatment of a fixed number of patients, makes it possible to reduce inpatient capacity in favour of improved community-integrated approaches for the treatment of acute psychiatric illness. RESULTS: In a first step inpatient capacity will be reduced by 8 percent. By the end of 2007 capacity for hospital day care shall be increased by 87 percent and a home treatment will be implemented. The previous working method, orientated to treatment setting, will be replaced by an approach specialized in diagnostic groups. CONCLUSIONS: The Regional Budget could improve the continuity and flexibility of patient care. Service providers become motivated to treat in a way, which with little resource consumption achieves a long lasting health status improvement. For health insurances the Regional Budget is an opportunity to limit cost increases.

Ambulatory Care↗
PubMed2003

Trade-off between immunocompetence and growth in magpies: an experimental study.

A trade-off between immunity and growth has repeatedly been suggested, mainly based on laboratory and poultry science, but also from experiments where parasitism intensity was manipulated in field bird populations. However, as resource allocation to different activities (or organs) during growth is difficult to manipulate, this trade-off has only been experimentally tested by studying the effects of non-pathogenic antigens. By providing some nestling magpies (Pica pica) with methionine, a sulphur amino acid that specifically enhances T-cell immune response in chickens, we investigated this trade-off by directly affecting allocation of limited resources during growth. Results were in accordance with the hypothetical trade-off because nestlings fed with methionine showed a lower growth rate during the four days of methionine administration, but a larger response when fledglings were challenged with phytohaemagglutinin (a measure of the intensity of T-lymphocyte-mediated immune responsiveness) than control nestlings. Surprisingly, we found that control and experimental nestlings fledged with similar body mass, size and condition, but experimental nestlings suffered less from blood parasites (Haemoproteus) and had fewer lymphocytes (a widely used measure of health status) than control nestlings, suggesting a negative effect of blood parasites or other pathogens on nestling growth.

Animals↗
PubMed1995

The biostatistician in medical research: allocating time and effort.

Biostatisticians in research juggle many responsibilities: short-term consulting; long-term collaboration; teaching/training, and statistical research. In an institutionally-supported service group, the biostatistician frequently faces allocation of limited resources (time and effort) over multiple projects, none of which individually supports the biostatistician. In addition to the level of support provided by a specific project, there are several major issues with resource allocation: the quality of the science and data in the project; the possibility that long-term support develops from the work; personal and institutional considerations that involve the specific investigator or project. In this paper, we discuss these considerations along with some examples. We present guidelines for making decisions about allocation of time and effort and the possible implications of setting such priorities.

Biometry↗
PubMed2001

Biological and social feasibility of Sesbania fallow practice in small holder agricultural farms in developing countries: a Zambian case study.

Many small holder farmers in developing countries face problems of declining soil fertility and crop yields and insufficient money to buy expensive inorganic fertilizers. The Sesbania fallow system, an agroforestry technology, seems to hold a key to these problems. Based on field studies in eastern Zambia, this paper reports that fallow system has the potential to improve and sustain soil productivity in the small holder farms. However, the paper also reports that the ability for subsistence farmers to adopt the Sesbania fallow system is affected by gender differences in resource allocation to productive resources and institutional, cultural, and social structural settings in which farmers exist and make decisions.

Agriculture↗
PubMed1996

Fast habituation of the long-latency auditory evoked potential in the awake albino rat.

Fast habituation of the long-latency, vertex-recorded auditory evoked potential (AEP) peaks in humans was first described by Callaway (1973) as a reduction in AEP amplitude that occurs to the second of a pair of acoustic stimuli when both stimuli are presented with an interstimulus interval (ISI) of no more than 10 sec. When acoustic stimuli are presented in pairs with an ISI of 2 sec and an interpair interval (IPI) of approximately 10 sec, reduction in amplitude to the second tone occurs by as much as 30-50%. Fast habituation may depend somewhat on a subject's anticipation of the stimulus and on other factors related to attention and orienting. Studies in our laboratory have demonstrated this amplitude decrement to the second tone of a pair in human infants, children and adults and have explored the implications of this finding with respect to attentional processes and the allocation of cerebral resources. In the present investigation we describe an animal model of fast habituation. Here, vertex-recorded AEPs were obtained to paired tone stimuli delivered to awake adult male Sprague-Dawley rats chronically implanted with skull electrodes. Findings showed: (a) an AEP wave form with 8 distinct peaks, (b) for one component there was a marked decrement in amplitude from tone 1 to tone 2 in recordings obtained from an electrode placed slightly to the right of midline, and (c) that there were no significant differences in peak latencies across tones. This methodology may further our understanding of fast habituation in humans and may prove useful for studies of attention, orienting, and resource allocation using techniques that are not possible for use with human subjects.

Acoustic Stimulation↗
PubMed1992

Reevaluation of organ transplantation criteria. Allocation of scarce resources to borderline candidates.

Organ transplantation in the 1960s proceeded according to a "lifeboat" ethics formula with physicians acting as "gatekeepers." Selection of transplant recipients is now based on medical urgency and waiting time. Some candidates continue to be given low priority by virtue of psychological impairment. The three As--advanced age, acquired immune deficiency syndrome (or positive human immunodeficiency virus status), and alcoholism--also stand out as characteristics that tend to exclude candidates. Cancer is another relative or absolute contraindication to transplantation. This article focuses retrospectively on the psychosocial and medical aspects of the decision to include six patients at Massachusetts General Hospital who were selected for organ transplantation despite their borderline candidacy. The authors introduce four lines of thinking that decision-makers might use to either include or exclude marginal candidates (e.g., the physician's interpretation of what duty requires, the patient's or surrogate's wishes, cost-benefit considerations, or the need for research to improve our scientific understanding of transplantation issues) and discuss an ethical approach that supports each line of thinking. The authors conclude that not all of the ethical approaches lead practitioners and policymakers to the same conclusions regarding the optimum size of or who should be a part of the recipient pool. The future of who receives transplants and why depends at least in part on the underlying ethical considerations that are deemed appropriate as determinants of practice and policy.

Adult↗
PubMed2001

Molecular signals versus the Loi de Balancement.

Life history tradeoffs are often thought to be caused by the allocation of limited resources among competing traits such as reproduction, somatic growth and maintenance. One line of evidence supporting this comes from eliminating reproduction, for example, by surgically removing gonads. However, recent evidence from the nematode Caenorhabditis elegans suggests that the apparent tradeoffs it shows might not be due to resource allocation at all but rather to the effects of a molecular signal originating in the germ line that represses longevity. These results should cause us to rethink the interpretation of many classic experiments in life history evolution.

Journal Article↗
PubMed1993

Public attitudes about the use of chronological age as a criterion for allocating health care resources.

We present the first systematic national survey of public opinion on age-based rationing of health care resources. Older people were oversampled in order to allow more precise comparisons of attitude by age cohort as well as by other demographic variables. We found that the majority of people accept the withholding of life-prolonging medical care to hopelessly ill patients, but few would categorically withhold such care on the basis of age. The majority of all ages felt that it was the duty of individual patients regardless of age to refuse medical care that is likely to be futile.

Adolescent↗