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PubMed1991

Differences in hospital resource allocation among sick newborns according to insurance coverage.

OBJECTIVE: To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services. DESIGN: Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition. SETTING: All California civilian acute-care hospitals. PATIENTS: Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751). MAIN OUTCOME MEASURES: Length of stay, total charges, and charges per day. RESULTS: Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured. CONCLUSIONS: The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.

California↗

PubMed2004

Towards a needs based mental health resource allocation and service development in rural and remote Australia.

OBJECTIVE: To develop a transparent, needs-based mental health resource allocation framework to guide area level service planning in rural and remote settings. METHODS: Using the Central Australian mental health service region as a case study, a five-step approach was used to analyse and gather relevant data as follows: (i) mapping a regional sociodemographic profile; (ii) estimating the expected level of mental illness within the regional population; (iii) estimating the expected level of specialist mental health service usage; (iv) estimating the expected categories of specialist mental health care required for the regional population; (v) making adjustments to the costs of providing specialist mental health care on the basis of demographic features of the region. These data were then matched with the availability, access and cost of specialist mental health care currently provided at the regional level. RESULTS: The capacity of specialist mental health care in Central Australia was below the expected benchmark for the population residing in this region. The region required approximately double the existing funding allocation to provide an adequate and equitable level of care that meets the needs of the diverse population groups. Children and adolescents were the group most in need, as were adult Aboriginal people living in remote settings. CONCLUSION: The framework described provides the beginnings of more open and transparent evidence-based decision-making regarding mental health resource allocation and service development for rural and remote residents.

Adolescent↗

PubMed1998

Resource allocation in general practice care.

OBJECTIVE: Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia. METHOD: Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice. RESULTS: There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested. CONCLUSIONS: Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Australia↗

PubMed2003

Temperature dependent larval resource allocation shaping adult body size in Drosophila melanogaster.

Geographical variation in Drosophila melanogaster body size is a long-standing problem of life-history evolution. Adaptation to a cold climate invariably produces large individuals, whereas evolution in tropical regions result in small individuals. The proximate mechanism was suggested to involve thermal evolution of resource processing by the developing larvae. In this study an attempt is made to merge proximate explanations, featuring temperature sensitivity of larval resource processing, and ultimate approaches focusing on adult and pre-adult life-history traits. To address the issue of temperature dependent resource allocation to adult size vs. larval survival, feeding was stopped at several stages during the larval development. Under these conditions of food deprivation, two temperate and two tropical populations reared at high and low temperatures produced different adult body sizes coinciding with different probabilities to reach the adult stage. In all cases a phenotypic trade-off between larval survival and adult size was observed. However, the underlying pattern of larval resource allocation differed between the geographical populations. In the temperate populations larval age but not weight predicted survival. Temperate larvae did not invest accumulated resources in survival, instead they preserved larval biomass to benefit adult weight. In other words, larvae from temperate populations failed to re-allocate accumulated resources to facilitate their survival. A low percentage of the larvae survived to adulthood but produced relatively large flies. Conversely, in tropical populations larval weight but not age determined the probability to reach adulthood. Tropical larvae did not invest in adult size, but facilitated their own survival. Most larvae succeeded in pupating but then produced small adults. The underlying physiological mechanism seemed to be an evolved difference in the accessibility of glycogen reserves as a result of thermal adaptation. At low rearing temperatures and in the temperate populations, glycogen levels tended to correlate positively with adult size but negatively with pupation probability. The data presented here offer an explanation of geographical variation in body size by showing that thermal evolution of resource allocation, specifically the ability to access glycogen storage, is the proximate mechanism responsible for the life-history trade-off between larval survival and adult size.

Adaptation, Physiological↗

PubMed1997

[Need-based resource allocation--experiences with the RAWP formula in Great Britain].

The RAWP formula used for resource allocation in Great Britain between 1976 and 1991 is a morbidity-oriented instrument of controlling, which has so far received only little attention in Germany. The development of this model was supported by the intention to intervene in the regional pattern of hospital supply by means of resource allocation and to refine it according to the guiding principles of equity and efficiency. The basic elements-regional population, average bed use, ICD chapter-specific SMRs-are discussed and the various modifications outlined. The RAWP formula's potentials of controlling resulted in a progressive reduction of the apparent disparities between regions in hospital supply, and knee was considered to be a "qualified success". The future development in the sense of an internal market addressed.

Budgets↗

PubMed1993

Ethical issues faced by clinician/managers in resource-allocation decisions.

This article explores the ethical issues faced by clinicians with management responsibilities (clinician/managers) when making decisions related to resource allocation and utilization at a Canadian teaching hospital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recurred throughout the discussions included fairness, concern with preventing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyzed from two perspectives--a theory of professional-bureaucratic roles and of obligation--that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for clinician/managers and that a better understanding of these issues can be obtained using an interdisciplinary perspective.

Canada↗

PubMed2000

Resource Allocation and the Evolution of Self-Fertilization in Plants.

This article develops a simple evolutionarily stable strategy (ESS) model of resource allocation in partially selfing plants, which incorporates reproductive and sex allocation into a single framework. The analysis shows that, if female fitness gain increases linearly with resource investment, total reproductive allocation is not affected by sex allocation, defined as the fraction of reproductive resources allocated to male function. All else being equal, the ESS total reproductive allocation increases with increasing selfing rate if the fitness of selfed progeny is more than half that of outcrossed progeny, while the ESS sex allocation is always a decreasing function of the selfing rate. Self-fertilization is much more common in annual than in perennial plants, and this association has been commonly interpreted in terms of an effect of life history on mating system. The model in this article shows that self-fertilization can itself cause the evolution of the annual habit. Incorporating the effects of pollen discounting may not have any influence on total reproductive allocation if female fitness gain is a linear function of resource investment, although the evolutionarily stable sex allocation is altered. Evolution of the selfing rate is found to be independent of reproductive and sex allocation under the mass-action assumption that self- and outcross pollen are deposited simultaneously on receptive stigmas and compete for access to ovules.

inbreeding depression↗

PubMed1997

Outcomes-based resource allocation for indigenous health services: a model for northern Australia?

Wide differentials continue to exist in mortality rates and other health outcomes between Aboriginal and non-Aboriginal Australians. In the Northern Territory (NT), where Aborigines make up 24% of the population, the all-causes age-adjusted Standardised Mortality Ratio for Aborigines compared to non-Aborigines has remained above 3 since the late 1970s, with significant regional variations. During 1995 an expenditure analysis was undertaken for primary health care (PHC) services in different regions of the NT and compared to mortality ratios. At the same time a method for needs-based funding was being developed which could replace the existing historical funding arrangements. In the first instance, the application of a simplified version of this Resource Allocation Formula (RAF) resulted in a significant shift of resources for new prevention program funding to regions of relatively high mortality and low per capita PHC expenditure. However, developing RAFs to redistribute at the margin within the NT is likely to generate further inequities between losing NT programs and counterparts in other states. If outcomes-based resource allocation is to be meaningful nationally, the reference point for the RAF should be national average PHC expenditure rather than existing state averages. There is a need for a combined approach to outcomes-based planning which takes into account both the equity arguments of resource allocation models and efficacy arguments to maximise health gains. Some of these arguments are explored in this paper.

Australia↗

PubMed2006

Benefits of all work and no play: the relationship between neuroticism and performance as a function of resource allocation.

The authors evaluate a model suggesting that the performance of highly neurotic individuals, relative to their stable counterparts, is more strongly influenced by factors relating to the allocation of attentional resources. First, an air traffic control simulation was used to examine the interaction between effort intensity and scores on the Anxiety subscale of Eysenck Personality Profiler Neuroticism in the prediction of task performance. Overall effort intensity enhanced performance for highly anxious individuals more so than for individuals with low anxiety. Second, a longitudinal field study was used to examine the interaction between office busyness and Eysenck Personality Inventory Neuroticism in the prediction of telesales performance. Changes in office busyness were associated with greater performance improvements for highly neurotic individuals compared with less neurotic individuals. These studies suggest that highly neurotic individuals outperform their stable counterparts in a busy work environment or if they are expending a high level of effort.

Adult↗

PubMed2000

Resource allocation during spoken discourse processing: effects of age and passage difficulty as revealed by self-paced listening.

The allocation of processing resources during spoken discourse comprehension was studied in a manner analogous to self-paced reading using the auditory moving window technique (Ferreira, Henderson, Anes, Weeks, & McFarlane, 1996). Young and older participants listened to spoken passages in a self-paced segment-by-segment fashion. In Experiment 1, we examined the influence of speech rate and passage complexity on discourse encoding and recall performance. In Experiment 2, we examined the influence of speech rate and presentation mode (self-paced vs. full-passage presentation) on recall performance. Results suggest that diminished memory performance in the older adult group relative to the young adult group is attributable to age-related differences in how resources were allocated during the initial encoding of the spoken discourse.

Adolescent↗

PubMed1987

Resource allocation in health care: the allocation of lifestyles to providers.

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗

PubMed1998

Resource-Allocation Strategies: A Verbal Protocol Analysis.

The current study examined the strategies used by people to solve resource-allocation problems. Verbal protocols were recorded as participants provided meal choices for seven consecutive days with limited resources available to spend on meals and with daily constraints imposed on meal consumption. None of the participants incorporated the established mathematical procedures (i.e., Linear Programming) to arrive at the optimum number of meals possible in a week. However, the strategies they did use enabled them to achieve meal totals on average at 94% of this optimal amount. A few participants attempted to first solve the maximum meals possible in a week before scheduling this solution across the seven days (solve-and-schedule strategy), but the majority of participants simply selected meals on a day-to-day basis while checking resource availability each day to allow for full resource consumption (consume-and-check strategy). The findings of this study provide a preliminary step toward understanding how people make intuitive resource-allocation decisions. Copyright 1998 Academic Press.

Journal Article↗

PubMed1997

Self-interest and fairness in problems of resource allocation: allocators versus recipients.

Two studies explored the tension between self-interest and the equality norm in problems of resource allocation. Study 1 presented graduate business students with a hypothetical task requiring them to make a series of managerial decisions. On learning the outcome of those decisions, they were asked to divide a bonus pool between self and a rival manager (who had opted for very different decisions and achieved either the same results as self on 2 criteria or a better result on 1 criterion and a worse result on the other criterion). Study 2 required Stanford and San Jose State undergraduates to consider the division of a hypothetical scholarship fund between candidates from their 2 schools. Data from both studies contrasted the apparent evenhandedness and lack of self-interest manifested by allocators with the self-serving responses of evaluators. Furthermore, when faced with different claims, participants were inclined to justify an unequal allocation of resources--provided that they, or a representative of their group, received the larger share--that few personally would have recommended, demanded, or imposed.

Defense Mechanisms↗

PubMed2006

VAPOR: variance-aware per-pixel optimal resource allocation.

Characterizing the video quality seen by an end-user is a critical component of any video transmission system. In packet-based communication systems, such as wireless channels or the Internet, packet delivery is not guaranteed. Therefore, from the point-of-view of the transmitter, the distortion at the receiver is a random variable. Traditional approaches have primarily focused on minimizing the expected value of the end-to-end distortion. This paper explores the benefits of accounting for not only the mean, but also the variance of the end-to-end distortion when allocating limited source and channel resources. By accounting for the variance of the distortion, the proposed approach increases the reliability of the system by making it more likely that what the end-user sees, closely resembles the mean end-to-end distortion calculated at the transmitter. Experimental results demonstrate that variance-aware resource allocation can help limit error propagation and is more robust to channel-mismatch than approaches whose goal is to strictly minimize the expected distortion.

Algorithms↗

PubMedDate not supplied

Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge?

BACKGROUND: An increasing number of health-care systems, both public and private, such as managed-care organizations, are adopting results from cost-effectiveness (CE) analysis as one of the measures to inform decisions on allocation of health-care resources. It is expected that thresholds for CE ratios may be established for the acceptance of reimbursement or formulary listing. OBJECTIVE: This paper provides an overview of the development of and debate on CE thresholds, reviews threshold figures (i.e., cost per unit of health gain) currently proposed for or applied to resource-allocation decisions, and explores how thresholds may emerge. DISCUSSION: At the time of this review, there is no evidence from the literature that any health-care system has yet implemented explicit CE ratio thresholds. The fact that some government agencies have utilized results from CE analysis in pricing/reimbursement decisions allows for retrospective analysis of the consistency of these decisions. As CE analysis becomes more widely utilized in assisting health-care decision-making, this may cause decision-makers to become increasingly consistent. CONCLUSIONS: When CE analysis is conducted, well-established methodology should be used and transparency should be ensured. CE thresholds are expected to emerge in many countries, driven by the need for transparent and consistent decision-making. Future thresholds will likely be higher in most high-income countries than currently cited rules of thumb.

Cost-Benefit Analysis↗

PubMed2004

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the 'instrumental' approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This 'procedural' approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992-2003 (calculated using a 'RAWP [resource allocation working party]-like' formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.

Budgets↗

PubMed2006

The soft constraints hypothesis: a rational analysis approach to resource allocation for interactive behavior.

Soft constraints hypothesis (SCH) is a rational analysis approach that holds that the mixture of perceptual-motor and cognitive resources allocated for interactive behavior is adjusted based on temporal cost-benefit tradeoffs. Alternative approaches maintain that cognitive resources are in some sense protected or conserved in that greater amounts of perceptual-motor effort will be expended to conserve lesser amounts of cognitive effort. One alternative, the minimum memory hypothesis (MMH), holds that people favor strategies that minimize the use of memory. SCH is compared with MMH across 3 experiments and with predictions of an Ideal Performer Model that uses ACT-R's memory system in a reinforcement learning approach that maximizes expected utility by minimizing time. Model and data support the SCH view of resource allocation; at the under 1000-ms level of analysis, mixtures of cognitive and perceptual-motor resources are adjusted based on their cost-benefit tradeoffs for interactive behavior.

Cognition↗

PubMed1990

A methodology for resource allocation in health care for South Africa. Part II. The British experience and its relevance to South Africa.

This second article in the series on resource allocation in health care, argues for a formula-based method of resource allocation in South Africa. The model employed in England since 1976 and its application in a number of developed and developing countries is reviewed. The international experience is related to South African conditions and the principal elements necessary for a formula to achieve greater spatial equity in South African health-resource distribution are discussed.

Delivery of Health Care↗