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PubMed1997

Autonomic orienting and the allocation of processing resources in schizophrenia patients and putatively at-risk individuals.

The differential allocation of attentional resources to attended and ignored stimuli was examined by measuring skin conductance orienting responses and secondary reaction time in relatively asymptomatic schizophrenia outpatients, demographically matched normal controls, college students putatively at risk for psychosis, and a college student control group. At-risk participants were those with extreme scores on scales for either anhedonia or perceptual aberration-magical ideation (per-mags). Compared to control groups, the patients and per-mags showed secondary reaction time results suggesting a delay in the differential allocation of attentional resources. This deficit was observed particularly in patients and matched controls with few or no skin conductance orienting responses, suggesting that impaired autonomic orienting is related to underlying cognitive-attentional vulnerability factors.

Adolescent↗

PubMed1995

Toward an improvement of life optimizing resource use.

In this paper an object-oriented system for the storing and the managing of epidemiological data in order to decrease the incidence of a given groups of diseases by means of health care strategy application and of the relative health care resource allocation is described. The system starts from the present epidemiological situation of the territory examined and from the real distribution on this territory of human and material health care resources. The health care manager inputs the available budget, some information regarding the population living on this area, other geographical and climatic informations, the values of certain epidemiological parameters of the diseases considered--the system has stored the mathematical and departmental models of these diseases--and the system allocates (using own allocation algorithms) human and material health care resources, optimizing the cost-benefit rate.

Algorithms↗

PubMed1991

Physician recruiting: do you know where your dollars go?

Time and resources spent on physician recruitment are investments that hospitals often overlook. While they may allocate resources for recruitment, many hospitals fail to analyze the value of recruitment dollars spent. By developing a physician search plan, however, a hospital can evaluate market demand for physicians, review ways to reduce physician turnover, and calculate a hospital's return on recruitment investments.

Budgets↗

PubMed2004

The public's preferences concerning the allocation of financial resources to health care: results from a representative population survey in Germany.

OBJECTIVE: The aim of the study is to examine to what extent the public is willing to allocate financial resources to the care of people with mental disorders. METHODS: In 2001, a representative survey was conducted among the adult population of Germany (n = 5025). The respondents were asked to select three out of nine conditions for which available resources should on no account be shortened. For data analysis, multiple unidimensional unfolding was used. RESULTS: Compared with medical diseases, the respondents were far less willing to allocate financial resources to the care of people with psychiatric disorders, making a clear distinction between the two types of diseases. While familiarity with mental illness had the effect of decreasing the reluctance to spend money for psychiatric patients, the endorsement of traditional values increased it. CONCLUSION: Our findings point to both the chances and the limitations of efforts aimed at reducing the structural discrimination of people with mental illness.

Adolescent↗

PubMed2000

The economic and social cost of dementia in Ireland.

The economic and social burden of dementia on society is the value of all the resources used to prevent, diagnose, treat, and generally cope with the illness. There is increasing pressure to define the cost components of dementia with a view to improving resource allocation and accountability in this area in the future. We have assessed the overall resource implications of dementia in Ireland. Six main areas are covered in the cost analysis as follows: mortality and life years lost, in-patient acute care, in-patient psychiatric care, residential long-stay care, family care, and primary and social care in the community. While the results indicate that the baseline cost of illness associated with dementia is substantial at just under IR pound250 million, the most important aspect of the work is the distribution of the burden. The critical role of carers in maintaining people with dementia in their own home is reflected in the results showing that family care accounts for almost 50% of the overall resource burden, based on an opportunity cost valuation of carer time.

Acute Disease↗

PubMed2000

A generalization of Pontryagin's maximum principle for dynamic evolutionary games among relatives.

We present two theorems that generalize Pontryagin's maximum principle to the setting of dynamic evolutionary games between genetically related individuals. The two theorems correspond to two types of interactions among individuals: patch-structured populations in which individuals locally "play the field" and pairwise interactions. These generalizations can be used in the same way that Pontryagin's maximum principle is used and they are valid for diploid organisms under a single locus, diallelic genetic model. These generalizations involve an interesting, dynamic version of Hamilton's Rule from inclusive fitness theory. We illustrate how these theoretical results can be applied by modeling the evolution of lifetime resource allocation to growth and reproduction in an annual plant when there is competition for resources among related individuals.

Biological Evolution↗

PubMed1994

A procedure for allocating a safety improvement budget among treatment types.

Highway agencies often have to decide how to allocate a road safety budget among different safety treatments. While some of the traditional resource allocation procedures can provide information to assist in making this decision, they are not tailor-made for this specific problem. In particular, uncertainty in accident frequency estimates can lead to difficulties if the procedure is inherently deterministic. A procedure is presented for using recent safety estimation theory and benefit-cost analysis to accommodate uncertainty in accident frequency estimates while addressing the specific decision-making problem at hand. In the procedure, a site can be treated if the difference between the safety benefit and the treatment cost--the net benefit--is large enough. Recognizing that safety benefits vary across sites and treatment types, the procedure allows a budget to be allocated to different programmes but ensures that the smallest net benefit--the net marginal benefit threshold--is the same for all programmes. The procedure estimates the number and costs of sites for each treatment type for which the net benefit exceeds a specific threshold that is adjusted such that the total treatment cost is in line with the available budget. While this methodology can be useful for agencies responsible for road safety improvements, the data requirements could pose a problem for some jurisdictions. A further difficulty is that the computations required are extensive, particularly in cases where uncertainty to other data items requires the use of sensitivity analysis. To facilitate these computations, a computer programme is available from the authors.

Accidents, Traffic↗

PubMed1997

High-resolution EEG mapping of cortical activation related to working memory: effects of task difficulty, type of processing, and practice.

Changes in cortical activity during working memory tasks were examined with electroencephalograms (EEGs) sampled from 115 channels and spatially sharpened with magnetic resonance imaging (MRI)-based finite element deblurring. Eight subjects performed tasks requiring comparison of each stimulus to a preceding one on verbal or spatial attributes. A frontal midline theta rhythm increased in magnitude with increased memory load. Dipole models localized this signal to the region of the anterior cingulate cortex. A slow (low-frequency), parietocentral, alpha signal decreased with increased working memory load. These signals were insensitive to the type of stimulus attribute being processed. A faster (higher-frequency), occipitoparietal, alpha signal was relatively attenuated in the spatial version of the task, especially over the posterior right hemisphere. Theta and alpha signals increased, and overt performance improved, after practice on the tasks. Increases in theta with both increased task difficulty and with practice suggests that focusing attention required more effort after an extended test session. Decreased alpha in the difficult tasks indicates that this signal is inversely related to the amount of cortical resources allocated to task performance. Practice-related increases in alpha suggest that fewer cortical resources are required after skill development. These results serve: (i) to dissociate the effects of task difficulty and practice; (ii) to differentiate the involvement of posterior cortex in spatial versus verbal tasks; (iii) to localize frontal midline theta to the anteromedial cortex; and (iv) to demonstrate the feasibility of using anatomical MRIs to remove the blurring effect of the skull and scalp from the ongoing EEG. The results are discussed with respect to those obtained in a prior study of transient evoked potentials during working memory.

Adult↗

PubMed1992

Use of the speed accuracy trade-off to characterize information processing in schizophrenics and normals.

Subjects performed a signal discrimination task under four conditions: normal pace, accuracy, speed, and SATO (equal effort to speed and accuracy). Characteristically, schizophrenics demonstrated decreased accuracy, poorer compliance, increased total response time, and increased simple reaction time. Surprisingly, central processing time (decision time) was equivalent. Analysis of processing resource allocation identified significant group differences only under the SATO condition. Here, controls balanced attentional resources but patients worked almost exclusively for speed. Under conjoint performance conditions, patients apparently minimize categorical processing time at the expense of accuracy. These data are interesting as they identify specific circumstances under which schizophrenics manifest an attentional deficit.

Adult↗

PubMedDate not supplied

Applying economic principles to health care.

Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.

Anti-Bacterial Agents↗

PubMedDate not supplied

Effects of migration on cancer incidence and resources for prevention and treatment in Florida.

Migration adds a complex dimension to the task of those who plan and allocate resources for health care. The authors offer a methodology for estimating the contribution of migration to the incidence of cancer, allow for age- and sex-specific cancer risks, and estimate, by country, the impact of recent migration on the annual incidence of cancer in Florida. Cancer and migration data were used to develop estimates of the number of cancer cases for Florida counties that were attributable to recent migrants. A net gain and loss ratio was calculated for new cancer cases in 1980 resulting from the 1975-80 migration pattern. Florida data was used because that State has one of the highest crude cancer incidence rates in the nation, is one of the most populous States, and has a population growth from migration rather than from natural increase. Preliminary findings on the relationship between cancer health services resources and net cancer rates from migration are discussed. County cancer health services resources had a strong positive relationship to population size, but the impact of migration on cancer incidence was in a curvilinear relationship to population size.

Cancer Care Facilities↗

PubMed1997

Service provision for people with schizophrenia. I. Clinical and economic perspective.

BACKGROUND: The aim of this study was to provide information on patients current service use which could inform future decisions on service planning and resource allocation. METHOD: Individuals with a diagnosis of schizophrenia, who had received in-patient care in the previous five years, were identified from the Lothian Case Register. Information was obtained from 193 subjects. Patients' service use over a six-month period was examined. The costs incurred in service provision were determined. RESULTS: Patients differed markedly in their use of services. This was not found to be related to their mental state. Average care costs were high. In-patient care accounted for most of the overall expenditure. CONCLUSIONS: There is considerable variation in the services used by patients with schizophrenia and in the costs incurred in service provision. When planning services it is therefore important that detailed information on the patient population is available if resources are to be allocated cost-effectively.

Adolescent↗

PubMed1991

Ethics and the allocation of health resources to the elderly.

This paper examines some of the ethical issues confronting the allocation of scarce health resources in the context of an ageing society with increasing levels of chronic disease. The allocation of resources at both the micro and macro level is explored, utilising the ethical principles of patient-centred beneficence, autonomy, full beneficence and justice. The implications of the dominance of science and technology within health care are analysed along with the paternalistic and individualistic nature of traditional medical ethics. The possible variations in value systems between patients and health professionals are examined and a greater emphasis on patient autonomy is advocated. Such a change, it is argued, may well result in an actual decrease in demand for expensive high technology treatment.

Aged↗

PubMed1980

Budget allocation in the National Health Service.

The objective of this article is to analyse the way in which budget allocation decisions have been made in the National Health Service (NHS) of Britain. Despite the criticisms of the pre-1948 health care system on the grounds of geographical inequity, it was not until nearly twenty-five years after the service's inception that explicit allocation formulae were devised and implemented in an attempt to achieve equity, defined as equal financial resources for health care for those in equal need. The article is divided into four sections; the first analyses briefly the establishment of the NHS in 1948 and the failure of policy-makers to rectify the significant inequalities in the distribution of health care inputs between the regions. The second section is concerned with the official recognition of the policy problem of geographical inequality in resources and the first attempt to rectify it. In the third section the most recent set of resource allocation formulae for England, Scotland and Wales will be analysed and compared. The final section offers some brief conclusions.

Budgets↗

PubMed1994

Technology management: case study of an integrated health system.

Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results.

Arizona↗

PubMed1997

Health care allocation and selective neglect in rural Peru.

This study of health care allocation to children in northern Puno, Peru, utilizes quantitative and qualitative data to explore differential resource allocation to children in rural Andean households. As part of a broader ethnographic study of health in two communities, quantitative data on reported health status, symptoms, and treatments (both lay and specialist) were collected for 23 children under the age of 7 over a one year period. Additional data were collected from local health post records. Data were analyzed by gender, and by three age groups (birth to 1 year, 1-3 years, 4-6 years) to determine if differences existed in the allocation of health care. The data suggest a pattern of discrimination against females and younger children, especially infants under age one, despite the fact that these groups were reported to be sicker. Differences were especially significant in the allocation of biomedical treatments, the most costly in terms of parental time, effort, and money. Ethnographic data on child illness, gender, and developmental concepts help to explain why children of different genders and ages may be treated differently in the rural andes. They provide a context in which to interpret health care allocation data, and, in the absence of a population-based study, reinforce findings based on the limited study sample. Female children are valued less because of their future social and economic potential. Females are also regarded to be less vulnerable to illness than male children, meaning that less elaborate measures are necessary to protect their health. Young children are thought to have a loose body-soul connection, making them more vulnerable to illness, and are though to be less human than older individuals. The folk illnesses uraña (fright) and larpa explain child deaths in culturally acceptable ways, and the types of funerals given to children of different ages indicate that the death of young children is not considered unusual. Health care allocation and ethnographic data suggest that selective neglect (passive infanticide) may be occurring in rural Peru, possibly as a means of regulating family size and sex ratio. It is important to go beyond placing blame on individual parents or on culture, however, to address the underlying causes of differential health care allocation, such as poor socioeconomic conditions, lack of access to contraceptives, and female subordination.

Age Factors↗

PubMed2005

Improved allocation of HIV prevention resources: using information about prevention program production functions.

To allocate HIV prevention resources effectively, it is important to have information about the effectiveness of alternative prevention programs as a function of expenditure. We refer to this relationship as the "production function" for a prevention program. Few studies of HIV prevention programs have reported this relationship. This paper demonstrates the value of such information. We present a simple model for allocating HIV prevention resources, and apply the model to an illustrative HIV prevention resource allocation problem. We show that, without sufficient information about prevention program production functions, suboptimal decisions may be made. We show that epidemiologic data, such as estimates of HIV prevalence or incidence, may not provide enough information to support optimal allocation of HIV prevention resources. Our results suggest that good allocations can be obtained based on fairly basic information about prevention program production functions: an estimate of fixed cost plus a single estimate of cost and resulting risk reduction. We find that knowledge of production functions is most important when fixed cost is high and/or when the budget is a significantly constraining factor. We suggest that, at the minimum, future data collection on prevention program effectiveness should include fixed and variable cost estimates for the intervention when implemented at a "typical" level, along with a detailed description of the intervention and detailed description of costs by category.

Canada↗

PubMed2002

Health care funding in New South Wales: from health care needs to hospital outputs.

This paper summarises the structure of the State's health care system, and then focuses on the main processes of resource allocation: needs-based funding of 17 Area Health Services, and output-based funding of specific service providers. The general model is widely accepted by informed observers to be fundamentally sound. In particular, the resource distribution formula whereby needs-based allocations are made is a largely valid model that has been progressively refined over fifteen years and is probably as good as any in the world. I conclude that the recent decision to require Area Health Services to use a common framework for out-put-based funding was long overdue, and that many of its features represent best practice. However, I argue that more should be done to refine some of the details and that NSW Health might need to give more consideration to ideas that have been tested and evaluated in other health care systems.

Adolescent↗