Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Resource Allocation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources
PubMed1998

'My ward is more deprived than yours'.

BACKGROUND: Increasingly, additional resources for infrastructure development and healthcare are directed at deprived areas. The commitment of the present government to reducing inequalities in health is likely to focus attention on identifying and providing special help to areas considered to be particularly deprived. This study compares the use of different deprivation measures at electoral ward level to rank wards according to deprivation and illustrates how the use of different deprivation measures may influence resourcing decisions. METHODS: The 20 local authority electoral wards making up the city of Plymouth, Devon, were studied. Some of the wards within Plymouth are amongst the most deprived in England. The scores for each ward for different measures of deprivation--Townsend, Jarman, the Department of Environment's Index of Local Conditions and Breadline Britain--were calculated and the wards ranked according to the deprivation score for each measure. Decisions on funding bids and resource allocation for wards within Plymouth were reviewed in the light of the relative deprivation status of the wards according to the various measures. RESULTS: The ranking of electoral wards for the selected measures of deprivation showed variation according to the measure used. The measure of deprivation chosen may have influenced resourcing decisions. CONCLUSION: Measures of deprivation are closely correlated one with another. However, by judicious choice of the deprivation measure used a ward can achieve a marked change in rank order. This may exert considerable influence on the decisions made by government departments, local authorities and health authorities when allocating resources.

England↗
PubMed2004

Assessing the performance of primary health centres under decentralized government in Kerala, India.

CONTEXT: Kerala's government health-care system functions relatively well compared with other Indian States, but utilization levels are decreasing due to lack of essential facilities. The opportunity cost of seeking medical care from the government sector is high, even for the poor, with 60-70% of the poor seeking care from the private sector and spending disproportionately on health care (about 40% of income compared with 2.4% by the rich). In 1996, the Kerala government brought primary health centres (PHCs) under the control of local governments (panchayats). OBJECTIVE: To provide an approach to assess PHC performance under decentralized government. METHODS: The study was conducted in three stages. The first stage included all 990 village panchayats in Kerala. The second stage covered 10 panchayats (their respective 10 PHCs and 65 sub-centres) occupying the top five and bottom five ranks in terms of resource allocation to health. Two panchayats (their respective PHCs and sub-centres), one each from the top five and the bottom five, were chosen for the third stage. Published and unpublished government data, panchayat development reports, panchayat and PHC records, facility checklist, and key informant and client exit interviews were used for data collection. FINDINGS: Panchayats in Kerala allocated a lower proportion of resources to health than that allocated by the state government prior to decentralization; while panchayat resources grew at an annual rate of 30.7%, health resources grew at 7.9%. PHCs were funded to the extent of 0.7-2.7% of the total cost. An additional 2% in PHC resources was associated with improved patient load (63.5%), cost-effectiveness (50.8%), medicine supply (49.4%), information (32.8%) and patient satisfaction (12.7%). An annual increase of US$940 in PHC resources would help to extend primary care facilities to 3000 (15.5%) more users. CONCLUSION: Decentralization brought no significant change to the health sector. Active panchayat support to PHCs existed in only a few places, but wherever it was present, the result was positive. Kerala should find an alternative strategy to channel panchayats towards health before health loses its battle for resources.

Efficiency, Organizational↗
PubMedDate not supplied

Enhancing the role of case managers with specialty populations: development and evaluation of a palliative care education program.

Palliative home care is an important component of the care system for patients at the end of life and case management is considered an essential element of the Canadian home care system. Case managers play a critical role in allocating resources, thus influencing the costs and the viability of palliative home care. Case management education programs focused on care coordination with specialty palliative care populations are nonexistent. An education program targeted at improving the knowledge and skills of case managers in allocating resources to palliative care populations was developed and pilot-tested in a metropolitan Canadian city home care program. Core curriculum was based on an initial learning needs assessment and used case-based problem solving to enhance case-management skills. An improvement in knowledge was noted on posttests and case managers described increased comfort and confidence in their role as case managers to this patient population. Home care organizations caring for palliative care populations must ensure case managers are prepared for case management roles with specialty populations if the home is to be rendered an appropriate and viable care setting for patients at the end of life.

Canada↗
PubMed1999

Reform of health insurance in the Federation of Bosnia and Herzegovina.

The aim of this report is to provide an overview of the reform of health insurance in the Federation of Bosnia and Herzegovina (FBH). Health financing and resource allocation policies in the FBH are also summarized. Health financing should be ensured through three types of health insurance: compulsory, supplementary, and voluntary. The revenues for the compulsory health insurance will be ear-marked through payroll taxation. Facing the scarcity of resources, the Federation authorities have decided to raise the proportion of the payroll contribution as compared to the pre-war level and engage in various arrangements of cost-sharing and priority setting in health care. The resource allocation policy underlines two key parts of the health care reform: contracting mechanisms and payment systems. We also discuss the optimal correlation between solidarity and competition in the course of the ongoing reform of the health insurance in the Federation. The social function of a competent health system, where the well-being of the population is viewed as a sociological category of the overall society's concern, requires considerable subsidization. Incentive-based market mechanisms may be introduced into some of the segments of health care system but only under government-led control of the effects of such measures.

Bosnia and Herzegovina↗
PubMedDate not supplied

Developing a decision support system to meet nurse managers' information needs for effective resource management.

This article describes the development of a decision support system called CLASSICA, which assists nurse managers in financial management, resource allocation, activity planning, and quality control. CLASSICA integrates information about patient flow and activity, staffing, and the cost of nursing care at the nursing-unit level. The system provides assistance in planning activities, balancing the budget, and identifying barriers to unsatisfactory resource management. In addition, CLASSICA contains forecasting and simulation options to analyze the influence of factors that affect nursing costs. This article describes the system's development process steps to tailor it to the needs of nurse managers and their existing work practices. Nurse managers actively participated in defining their tasks and responsibilities; identified barriers and difficulties in managing these tasks; defined information needs, data input, and output and interface requirements; and identified expected benefits. Clear communication of project goals, strong user involvement, and purposeful benefit planning was used to achieve the goals for CLASSICA: (1) to provide essential information and decision support for effective financial management, resource allocation, activity planning, and staffing; (2) to improve nurse managers' competence in financial management and decision making; (3) to improve cost containment; and (4) to provide a helpful and easy to use tool for decision support.

Decision Support Systems, Management↗
PubMed2001

Equity considerations in health care: the relevance of claims.

The general issues of equity and efficiency are central to the analysis of resource allocation problems in health care. We examine them using axiomatic bargaining theory. We study different solutions that have been proposed and relate them to previous literature on health care allocation. In particular, we focus on the solutions based on axiomatic bargaining with claims, and show that they are appealing as distributive criteria in health policy. Finally, we present the results of a survey that tries to elicit moral intuitions of people about resource allocation problems and their different solutions.

Collective Bargaining↗
PubMed1997

[Economic assessment of the epidemiological profile change: information for health care reforms].

Taking into account the information needed to implement the reform process of the health sector, we present the results of an analysis of costs and the financial consequences of the epidemiological change of four tracer diseases in Mexico, two chronic (diabetes and hypertension) and two infectious diseases (pneumonias and diarrheas). The hospital cost-case management of diabetes expected for 1998 represents the same amount of hospital and ambulatory case management of diarrheas and pneumonias for the same year. The internal competition for resource allocations that is expected, among other factors, is one of the results that permits the argument that changes in the epidemiological profile generate relevant financial consequences in the planning and implementing of structural reforms of the health systems, particularly with regards to the patterns of resource allocation for specific health programs.

Chile↗
PubMed2003

The burden of brain diseases in Europe.

The burden [as defined by the World Health Organisation (WHO)] of brain diseases (neurological, neurosurgical and psychiatric diseases together) is very high and yet resources spent on these diseases are not necessarily commensurate with the extent of this burden. However, hard data on the burden of brain diseases in Europe have not previously been easily accessible. The Global Burden of Disease (GBD) 1990 study conducted jointly by the WHO, Harvard University and the World Bank provided new measures that are now becoming universally accepted and have been used also in a repeat study: The GBD 2000. The key parameter of the study is disability adjusted life years (DALY), which is the sum of years of life lost (YLL) caused by premature death and years of life lived with disability (YLD). In the present report, data from the GBD 2000 study and from the World Health Report 2001 on brain diseases is extracted for the territory of Europe. This territory corresponds roughly to the membership countries of the European Federation of Neurological Societies. The WHO's Report has a category called neuropsychiatric diseases, which comprises the majority but not all the brain diseases. In order to gather all brain diseases, stroke, meningitis, half of the burden of injuries and half of the burden of congenital abnormalities are added. Throughout Europe, 23% of the years of healthy life is lost and 50% of YLD are caused by brain diseases. Regarding the key summary measure of lost health, DALY, 35% are because of brain diseases. The fact that approximately one-third of all burden of disease is caused by brain diseases should have an impact on resource allocation to teaching, reasearch, health care and prevention. Although other factors are also of importance, it seems reasonable that one-third of the curriculum at medical school should deal with the brain and that one-third of life science funding should go to basic and clinical neuroscience. In addition, resource allocation to prevention, diagnosis and treatment of brain diseases should be increased to approach, at least, one-third of health care expenditure. With the present data on hand, neurologists, neurosurgeons, psychiatrists, patient organizations and basic neuroscientists have a better possibility to increase the focus on the brain.

Adolescent↗
PubMedDate not supplied

Clinical practice and the UK Human Rights Act 1998: protecting individual rights in the interest of the wider community.

Health professionals have expressed concern that the UK Human Rights Act 1988, which came into force in 2000, may threaten their autonomy in clinical practice/decision-making and resource allocation by health authorities. Although healthcare-related cases have so far been slow to emerge under the Act, it seems clear that in clinical practice the transition from duty to legal obligation will involve a degree of change for health professionals, in attitude if not in behaviour. With regard to resource allocation, it appears that the UK courts are likely to consider challenges to health authorities' decisions in a way that takes into account the need to set priorities, so long as these decisions do not discriminate unfairly and can be shown to have been made in the best interest of the wider community.

Health↗
PubMed1991

The dangers resulting from inaccurate computer-based operative records.

The accuracy of a computer-based recording system of operative procedures was audited at a major district general hospital. The system is supposed to provide accurate records of theatre activity, to allow for improved nursing resource allocation and provide surgeons with a basic record of their operations. Mistakes were present in the details of 27% of the cases entered. Such inaccuracies highlight a major danger to surgeons with regard to their accountability for operations attributed to them. Mistakes can only cause further problems with regard to audit and future resource allocation.

Documentation↗
PubMed2005

Shrinking areas and mortality: an artefact of deprivation effects?

There is evidence that mortality rates are highest in areas that are experiencing population decline, and researchers have recommended that this should be accounted for in health resource allocation. This research finds a significant negative association between population change and mortality for small areas in Scotland, which remains when low social class is accounted for. However, this relation disappears when the area deprivation is accounted for. It is suggested that it is more important to account for deprivation than population change in health resource allocation.

Censuses↗
PubMed1994

Cost containment: the Americas. Canada.

Resources allocated for health care in Canada are about to be decreased. In recent years, the Canadian healthcare system has been consuming a progressively greater share of the country's gross domestic product. Due to recession, less revenue is available for health care. The need to contain and limit national healthcare spending has begun to affect resource allocation in Canadian ICUs. Increasing efficiency and reducing inappropriate use may not be enough to contain costs. More difficult decisions need to be made.

Canada↗
PubMed1987

Activities of daily living as quantitative indicators of nursing effort.

Functional assessments of elderly or disabled people requiring long-term care have been used by clinicians for many years, and functional assessment instruments are now being used as indicators of required nursing care and its cost. The authors examine the ability of functional assessment items and instruments to measure accurately the variation in nursing care used by nursing home patients, with analysis of 290 patients. Nursing times, measured for each patient by nurse category (registered and all other) and type of care (skilled and personal) measure resource consumption. Activities of daily living (ADLs): eating, bathing, dressing, toileting, transferring, and continence are used to measure functional abilities on a four-point scale: independent, supervised, assisted or helped, and dependent, as well as two derived scales: Katz's Index and Resource Utilization Groups. The four-point measurement scales for ADLs are found to be necessary as indicators of nursing time required by patients. As a consequence, the three-point scales used for ADLs in the Long-term Care Minimum Data Set are not adequate, at least in nursing homes, for resource allocation. The relationship of nursing times with individual ADLs is nonlinear, so linear statistical techniques such as principal components, canonical correlations, or linear regression are inappropriate to produce patient classification systems based on ADLs. Individual ADLs do not explain use of registered nursing care time as well as they do care time by other nursing staff. Therefore, resource allocation and staffing for registered nurses must be done separately from nursing personnel, using indicators other than ADLs.

Activities of Daily Living↗
PubMed1997

Informing prescribing allocations at district level in England.

OBJECTIVES: To derive a predictive model based on the morbidity, demographic and socio-economic characteristics of district populations to explain variations in prescribing costs in England. METHOD: Inter-relations between morbidity, demographic, socio-economic, general practice supply characteristics and net ingredient cost per age, sex and temporary resident originated prescribing unit (ASTRO-PU) were explored statistically for 90 districts in England using 1994 cost data. The possibility of mutual inter-relationship between 'supply' and 'demand' was examined; then the associations between a range of factors and prescribing costs were estimated using ordinary least squares regression and the predictive power of the possible models was systematically examined. RESULTS: Whilst there was a relatively weak relationship between the supply factors that were measured, there did not appear to be any reciprocal relationship. Three parsimonious models estimated using ordinary least squares multiple regression techniques based on combinations of permanent sickness, low birth weight and the proportion of general practitioners registered for postgraduate certificate of education were identified. The models explained up to 61% of variation between districts in prescribing costs. CONCLUSIONS: 'Need' and 'supply' characteristics are independently associated with variations in prescribing costs at district level. The negative association between the proportion of general practitioners eligible for postgraduate education allowance and prescribing costs may reflect 'better' prescribing but could not be introduced into a resource allocation formula without introducing perverse incentives. The combination of permanent sickness and low birth weight complement each other by providing a proxy measure of morbidity mostly applicable to adult males (permanent sickness) and mothers (low birth weight being a measure of maternal health). These variables should be considered further for use in the process of allocating resources for prescribing to districts.

Cost Allocation↗
PubMed1994

General practitioners' views about the statutory annual practice report.

OBJECTIVE: To ascertain the views of primary care professionals about the current purpose, uses, potential, and workload implications of the statutory general practice annual report. DESIGN: Postal questionnaire survey. SETTING: General practices in the Northern region. SUBJECTS: All practices in the region that were singlehanded, fundholding, non-fundholding and with more than five partners, and a one in three random sample of all non-fundholding practices (n = 318). RESULTS: 263 practices responded (83%). The report took a median of 12 hours to produce (95% confidence interval 11 to 15 hours; interquartile range 7-35). The main perceived purpose of the report was to monitor practice activity (165 respondents; 63% (95% confidence interval 57% to 69%)), but 44 respondents (17%; 13% to 22%) produced it only because it was contractually required. Practices included statutory and non-statutory data in these reports and would have liked comparative practice activity information (155 respondents; 59%) and "good ideas" (165 respondents; 63%) fed back to them. Respondents would have liked the annual report used to improve practice development planning (122 respondents; 46% (40% to 52%)), to facilitate audit (115 respondents; 44% (38% to 50%)), and to influence resource allocation (104 respondents; 40% (34% to 46%)). One hundred and eighteen practices (45%; 39% to 51%) would produce an annual report even if not contractually required. Data collected were perceived to be already available elsewhere. CONCLUSIONS: Primary care professionals have concerns about the current annual report. They would prefer to collect relevant, standardised data which could lead to better audit, planning, and resource allocation.

Annual Reports as Topic↗
PubMedDate not supplied

Assessing preferences for prevention versus treatment using willingness to pay.

BACKGROUND: Rising health care costs and limited resources necessitate trade-offs between resources allocated toward prevention and those toward treatment. Information from opinion polls suggests citizens favor spending a higher proportion of all health care dollars on prevention rather than treatment. OBJECTIVES: To assess the policy implications of willingness to pay (WTP) for use in cost-benefit analysis (CBA) as a method for capturing individual preferences for prevention and treatment in the context of resource allocation decisions. METHODS: The authors recruited a random sample of 1456 US residents age 18 years and greater by telephone using random-digit dialing. The survey was designed as a 3-stage (phone-mail-phone) process and was conducted between December 1998 and March 1999. For all persons completing the survey (N = 1104), the authors 1st collected respondents' opinions about the costs and effectiveness of prevention versus treatment programs in general. Half of respondents were then asked to state their WTP for a hypothetical prevention scenario and half were asked to state their WTP for a hypothetical treatment scenario. Both scenarios were specific to the same health context and included an identical reduction in mortality risk. RESULTS: WTP for treatment was significantly greater than WTP for prevention, $665 and $223, respectively. Prior opinions on the relative effectiveness afforded by preventive and treatment interventions moderately influenced the WTP estimates for persons randomized to either scenario. Prior opinions on costs had no significant effect on WTP estimates for either scenario. WTP significantly increased with age and household income in the full sample but was not significantly affected by gender or educational attainment. CONCLUSIONS: The aggregated WTP responses from the prevention and treatment scenarios presented in our study would imply that treatment is more strongly preferred by society than prevention when the health context is the same and benefits of each are held constant. A better understanding is needed of the discrepancy between citizens' stated preferences for prevention (e.g., through polling) and our findings that they were willing to pay substantially more for treatment than for prevention.

Adult↗
PubMed1995

Decision analysis: a practical example.

Cancer treatment is often perceived as too toxic, ineffective, and costly, compared with other medical treatments. Decision analysis attempts to define the effectiveness of alternative strategies, then incorporates patient preferences and the cost of care to allow comparisons of cost effectiveness. The provider benefits by being forced to "quantify the qualifiers" and explicitly determine which treatment is better and by how much. The health economist can use decision analysis to allocate resources based on the maximum years of life gained for the least amount of dollars spent. Clinical trialists can use decision analysis to ask "what if" questions about different alternative strategies or assumptions of effectiveness, or to perform computer simulations of interesting but untried clinical trials. Providers and payers can use dollars per life-year gained as one index to help rationally allocate resources. The authors present a practical example of the uses of decision analysis in determining the value to society of high-dose chemotherapy for high-risk stage II breast cancer patients.

Antineoplastic Agents↗
PubMedDate not supplied

Immunisation strategies for viral diseases in developing countries.

In just under a quarter of a century, the Expanded Programme on Immunisation has been associated with an increase in infant immunisation coverage from around 5% to 80%, and the prevention of at least 3 million deaths annually, at very low cost. The global target of poliomyelitis eradication by the year 2000 appears feasible. Measles is the next likely target for eradication via immunisation, through 'catch-up', 'keep up' and 'follow-up' strategies which have proven highly effective in the Americas. Yet much needs to be done in order to extend readily achievable immunisation benefits equitably to all the world's people and to realise the potential of existing and soon to be available vaccines for disease control and eradication, as experience with yellow fever and hepatitis B vaccines demonstrates. Unsafe injection practices are widespread, have received inadequate attention, and cause a substantial global burden of blood-borne infections. The risk of increasing global inequity in immunisation highlights the centrality of resource allocation priorities in determining the extent to which the benefits of immunisation will be realised, particularly for new vaccines which are significantly more costly than established EPI vaccines. WHO/UNICEF strategies to target more effectively immunisation support to the neediest countries, to prioritise new vaccines, and to target carefully vaccine procurement and encourage sharply tiered vaccine pricing support both equity and sustainability. However, increasing the resources available to immunisation is vital and requires powerful advocacy on public health, moral, cost-effectiveness and legal grounds. More appropriate resource allocation priorities could readily provide the means necessary to address both technical and operational immunisation challenges.

Child↗