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PubMed1978

Subregional resource allocations in the National Health Service.

The Resource Allocation Working Party in its report Sharing Resources for Health in England proposes a formula for the identification of both regional and district financial targets (Department of Health and Social Security, 1976). In this paper it is argued that the national formula is not a valid instrument for the latter purpose. Furthermore, research into medical needs and outcomes will not be adequate to bring about real changes in resource distribution at local levels unless it is recognised that the health authorities can meet needs in different ways and that a change in resource management from institutional to service budgeting is required.

Catchment Area, Health↗
PubMed1988

Resource allocation in multifacility emergency medical service systems.

As instruments of public policy, Emergency Medical Service Systems must not only make effective use of the available resources but also ensure that those resources are shared equitably by the systems' facilities. This paper develops a multifacility EMS system resource allocation model that enables its user to evaluate the equitability of resource allocation schemes. Recognizing and objectively defining the relationships between the consumption of system resources and the provision of EMS System services, this model is appropriate for use in both prospective and retrospective EMS System resource allocation analyses.

Cost Allocation↗
PubMed1997

A linear goal programming model for human resource allocation in a health-care organization.

This paper presents the development of a goal programming (GP) model as an aid to strategic planning and allocation for limited human resources in a health-care organization. The purpose of this study is to assign the personnel to the proper shift hours that enable management to meet the objective of minimizing the total payroll costs while patients are satisfied. A GP model is illustrated using the data provided by a health-care organization in the midwest area. The goals are identified and prioritized. The model result is examined and a sensitivity analysis is performed to improve the model applicability. The GP model application adds insight to the planning functions of resource allocation in the health-care organizations. The proposed model is easily applicable to other human resource planning process.

Algorithms↗
PubMedDate not supplied

[Social deprivation and mental health. Replicability and applicability in the Italian context of the resource allocation methods developed in the United Kingdom].

AIMS: Most of the available evidence on the relationship between socioeconomic indicators of social deprivation and patterns of use of mental health services has been produced in the United Kingdom, where the Ministry of Health has developed a resource allocation formula based upon the results of those studies. The main aim of the paper is to evaluate the replicability in the Italian context of such research, and of the resulting allocation strategies. METHODS: Detailed description of the resource allocation method currently adopted in the United Kingdom, whose main purpose consists in reaching the best balance between available funding and patterns of need. Detailed description of resource allocation processes in Italy; discussion of the main methodological and statistical limitations restraining the replicability of the British formula in the Italian context. CONCLUSIONS: There is a growing interest in Italy towards the introduction of evidence-based methods in health decision making, in order to correct the overwhelming influence of political issues. What is needed is a better understanding of the relationship between higher levels of equity in health services access, and their effects in terms of better outcomes.

Feasibility Studies↗
PubMed1995

Resource allocation, health policy, and rationing craniofacial care.

The United States allocates health care without an overt system of rationing. This article analyzes the forces that guide resource allocation to craniofacial care. Various possible allocation systems are reviewed for how decision makers might evaluate proposed programs for legislative funding. Using a case-based exercise, readers are asked to weigh the potential costs and benefits of six health and social programs. These programs are also systematically examined for factors that are likely to affect resource allocation decisions. Eleven factors that affect decision-making are utilized in the analysis, ranging from the cost per client to emotional or human interest content of the proposed programs. Decisions about preventive programs are compared with those involving therapeutic programs. The allocation of resources to craniofacial programs, including those for children with rare major craniofacial conditions, is considered in the context of social justice and broad contemporary ethical and health care delivery issues.

Acquired Immunodeficiency Syndrome↗
PubMed2003

How do people learn to allocate resources? Comparing two learning theories.

How do people learn to allocate resources? To answer this question, 2 major learning models are compared, each incorporating different learning principles. One is a global search model, which assumes that allocations are made probabilistically on the basis of expectations formed through the entire history of past decisions. The 2nd is a local adaptation model, which assumes that allocations are made by comparing the present decision with the most successful decision up to that point, ignoring all other past decisions. In 2 studies, participants repeatedly allocated a capital resource to 3 financial assets. Substantial learning effects occurred, although the optimal allocation was often not found. From the calibrated models of Study 1, a priori predictions were derived and tested in Study 2. This generalization test shows that the local adaptation model provides a better account of learning in resource allocations than the global search model.

Adult↗
PubMed2000

Does managed care more efficiently allocate resources to older patients in critical care settings?

OBJECTIVE: To evaluate resource utilization by elderly patients with respiratory failure in order to compare the efficiency of managed care and non-managed care payers. DESIGN: Regression analysis is applied to predict survival rate and the payments per life saved as a function of managed care participation, sociodemographics, and clinical risk factors. SETTING: Acute care hospitals in New York State. PATIENTS: Patients discharged under DRG 483 during 1992-1996. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Predicted payments were compared to the value of extending life for each payer subset, with and without quality of life adjustments, in order to determine when net benefits were maximized. Payments per life saved increased steadily for both groups (managed care and non-managed care) with age, with the non-managed care payments increasing more rapidly than managed care payments. Benefits equaled costs in the same age ranges for both payer groups, although the age at which benefits equaled costs was 93 for managed care patients and 91 for non-managed care patients. Resources are allocated efficiently for most patients regardless of payer. CONCLUSIONS: Managed care patients with DRG483 had higher rates of survival. Resource utilization efficiency was not affected by payer source.

Adolescent↗
PubMed1983

Health care technology and the inevitability of resource allocation and rationing decisions. Part I.

Increasingly, it is recognized that resources available to meet health care needs are limited. Recently, this has been evidenced by reductions in federally funded health care programs and the leveling off of research funds made available to the National Institutes of Health. The problem of severely constrained resources is likely to become more acute, given new medical technology and the high cost of medical care. It is now apparent that both resource allocation and resource-rationing decisions will become inevitable, since not all persons with catastrophic or complicated medical conditions will be able to benefit from medical technology. While the careful assessment of health care technology can conceivably increase the efficiency of the health care delivery system, the methods by which allocation and rationing decisions are made must be improved. In doing so, it will ultimately be essential for this society to come to grips with life and death issues in a manner to which it is not accustomed.

Biomedical Research↗
PubMed1997

Dialogue. Resource allocation: to those in the greatest need or those who will benefit most?

The behavioral healthcare community seeks universal coverage for mental health and addiction treatment services at parity with coverage for other medical conditions. To achieve this goal, our field must accept and work within realistic financial limits. The time has come to establish a framework for "rational rationing" of behavioral healthcare resources. What are the priorities? How should resources be equitably shared? Should we sacrifice people with mild and moderate disabilities and illness in order to spend most of our dollars on people who are severely impaired? Our first writer, Dr. Daniels, warns us that there are no moral tenets upon which we can easily or comfortably hang our hats, as he shares the current perspective of medical bio-ethics. Dr. Sabin is a practicing psychiatrist at Harvard Pilgrim Health Care. He highlights the Oregon health Plan as one example of political fortitude and wisdom in resolving healthcare resource allocation challenges. Mac Crawford, chairman of the board and chief operating officer of Magellan Health Services, is in one of the most influential positions in private sector integrated behavioral services delivery. He stresses the importance of managed care and clinical process standardization as fundamental requirements for the rational allocation of resources. One additional note: The lack of a consumer voice in this Dialogue is an unfortunate consequence of the mismatch between submissions received and our publication deadlines. It was our intention to present the perspective of a prominent individual from the growing field of consumer and family advocacy. We apologize for the lack of this perspective, which may have extended this discussion to the practical implications of this abstract question of resource allocation.

Cost-Benefit Analysis↗
PubMed1995

Geographical resource allocation in the English National Health Service, 1971-1994: the tension between normative and empirical approaches.

The policy response to the problem of developing a geographical resource allocation formula sensitive to relative population needs for hospital and community health services resources in the National Health Service demonstrates a continuing tension between normative and empirical solutions. Since 1988, the balance has shifted in favour of a more empirical approach to identifying and weighting population needs indicators in response to concerns about the theoretically justified, but essentially approximate, nature of the Resource Allocation Working Party formula introduced in 1977-1978. However, judgements and assumptions about the nature of 'need' have still to be made in order to construct a usable resource allocation formula since empirical data on what is cannot provide a complete guide to what ought to be a fair distribution of resources in relation to need.

Capital Financing↗
PubMed1997

An ethics framework for assisting clinician-managers in resource allocation decision making.

In response to continued pressure on the Canadian healthcare system, hospitals are implementing structural changes to address issues of cost containment, utilization, and resource allocation. One strategy has been to decentralize managerial decision making to clinicians, creating "clinician-managers" (CMs). We surveyed 3,000 hospital-based CMs in Ontario, Canada (including physicians, nurses, and other health professionals), in order to understand the nature and frequency of the ethical issues they face as a consequence of their involvement in resource allocation decisions, and to identify mechanisms for dealing with these problems in their hospitals. Based on the survey results, we developed a Management Ethics Framework to assist CMs to reach an ethically justifiable resolution of these types of problems, both individually, and in the context of their membership in the healthcare team. The results, and particularly the discussion that follows, represent a confluence of philosophical, clinical, and organizational perspective on ethics and resource allocation by clinicians.

Attitude of Health Personnel↗
PubMed1998

Resource allocation during the rereading of scientific texts.

Two experiments examined how cognitive resources are allocated to comprehension processes across two readings of the same scientific texts. In Experiment 1, readers read and later reread texts describing scientific topics. The results indicated that across readings, readers decreased resources allocated to proposition assembly, increased resources allocated to text-level integration, and expended a similar amount of resources to lexical access. Subjects who reread the texts after a week delay showed a similar pattern, except that they did not show the increase for text-level integration. Experiment 2 revealed a similar pattern of results with a moving window procedure, except that there was a significant decrease in resources allocated to lexical access across exposures. This experiment also indicated that the rereading speedup was greatest at sentence boundaries, suggesting that the prior exposure enabled readers to immediately process each word. Overall, the results are consistent with the claim that readers allocate proportionally more available resources to text-level integration during rereading because proposition assembly, which enables text-level integration, can be completed with fewer resources.

Adult↗
PubMed2005

Physicians' perceptions and attitudes regarding inappropriate admissions and resource allocation in the intensive care setting.

BACKGROUND: Physicians' perceptions regarding intensive care unit (ICU) resource allocation and the problem of inappropriate admissions are unknown. METHODS: We carried out an anonymous, self-administered questionnaire survey to assess the perceptions and attitudes of ICU physicians at all 20 ICUs in Milan, Italy, regarding inappropriate admissions and resource allocation. RESULTS: Eighty-seven percent (225/259) of physicians responded. Inappropriate admissions were acknowledged by 86% of respondents. The reasons given were clinical doubt (33%); limited decision time (32%); assessment error (25%); pressure from superiors (13%), referring clinician (11%) or family (5%); threat of legal action (5%); and an economically advantageous 'Diagnosis Related Group' (1%). Respondents reported being pressurized to make more 'productive' use of ICU beds by Unit heads (frequently 16%), hospital management (frequently 10%) and colleagues (frequently 4%). Five percent reported refusing appropriate admissions following 'indications' not to admit financially disadvantageous cases. Admissions after elective surgery prioritized patients from profitable surgical departments: frequently for 6% of respondents and occasionally for 15%. Sixty-seven percent said they frequently received requests for appropriate admissions when no beds were available. This was considered sufficient reason to withdraw treatment from patients with lower survival probability (sometimes 21%) or for whom nothing more could be done (sometimes 51%, frequently 11%). CONCLUSIONS: Inappropriate ICU admissions were perceived as a common event but were mainly attributed to difficulties in assessing suitability. Physicians were aware that their decisions were often influenced by factors other than medical necessity. Economic influences were perceived as limited but not negligible. Decisions to forgo treatment could be influenced by the need to admit other patients.

Adult↗
PubMed1992

The New South Wales Resource Allocation Formula: a method for equitable health funding.

The Resource Allocation Formula has been developed to guide the allocation of health resources in NSW. The aim of the formula is to achieve a more geographically equitable distribution of resources compared to the concentration of facilities which resulted from the historical method of allocating on the basis of past expenditure. A key innovation in the formula is the separation of funding for tertiary referral services using Diagnosis Related Groups. Tertiary services are funded separately and assessed on the present and projected statewide activity levels. By contrast, primary and secondary health services are to be funded on the basis of adjusted population relativities. The formula, which has been approved for use in NSW sets notional target shares for each Area and Region ten years hence. Implementation of these shares is to be achieved through a progressive redistribution of funds.

Ambulatory Care↗
PubMed2026

Coarse-grained resource allocation modeling for decoding and rewiring microbial metabolism.

Microbial metabolism is a complex, emergent system driven by the coordinated interplay of intricate and dynamic molecular processes. To elucidate cellular behavior and enable biotechnological applications, quantitative models that address the inherent complexity of metabolism have been developed from a resource allocation perspective. Here, we synthesize recent advances in coarse-grained resource allocation frameworks and their applications in understanding microbial physiology and guiding gene circuit design. These frameworks reveal global regulatory constraints and predict cellular adaptation to nutrient and environmental changes. In addition, they enable the quantification of metabolic costs, the dissection of circuit-host interactions, and the development of strategies for burden mitigation. Collectively, these modeling frameworks provide a powerful platform for uncovering quantitative principles of microbial growth and engineering robust synthetic biological systems.

coarse-grained modeling↗
PubMed2003

Setting priorities and allocating resources in health regions: lessons from a project evaluating program budgeting and marginal analysis (PBMA).

BACKGROUND: Program budgeting and marginal analysis (PBMA) is a framework for setting priorities in health care, used internationally over the last 25 years in Britain, Australia and New Zealand. However, the framework has undergone limited evaluation, and insight into how such evaluation should even take place is not found in the literature. METHODS: Seven PBMA case studies were conducted in three Canadian health regions to examine the feasibility of applying the PBMA framework. Structured follow-up surveys with the users of the framework were carried out following the priority setting exercises. RESULTS: The PBMA framework was feasibly implemented in three regionalized contexts and was generally viewed favorably by managers and clinicians who participated in the case studies. Numerous methodological lessons were learned and it was found that successful implementation hinges on organizational context. An empirically derived model describing PBMA is outlined and put forth as an evaluation framework for future exercises. CONCLUSIONS: Comparisons to the health care management literature indicate that the derived PBMA model is a novel addition to this broader literature. Overall, managers in health organizations internationally would be well-served to consider PBMA to aid regional decision-making processes, but should do so with explicit consideration of the context in which such activity is to occur.

Alberta↗
PubMed1996

Mechanisms of visual-spatial attention: resource allocation or uncertainty reduction?

Many studies have found that stimuli can be discriminated more accurately at attended locations than at unattended locations, and such results have typically been taken as evidence for the hypothesis that attention operates by allocating limited perceptual processing resources to attended locations. An alternative proposal, however, is that attention acts to reduce uncertainty about target location, thereby increasing accuracy by decreasing the number of noise sources. To distinguish between these alternatives, we conducted 6 spatial cuing experiments in which target location uncertainty was eliminated. Despite the absence of uncertainty, target discriminations were more accurate at the attended location, consistent with resource allocation models. These cue validity effects were observed under a broad range of conditions, including central and peripheral cuing, but were absent at very short cue-target delay intervals.

Attention↗