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At least 1,315 records · Page 73Linked to original sources
PubMed2000

Age-based rationing in the allocation of health care.

OBJECTIVES: This article seeks to review debates about age-based rationing in health care. METHODS: The article identifies four different levels (or types) of decision-making in health resources allocation--societal, strategic, programmatic, and clinical--and assesses how the issues of rationing vary in relation to each level. RESULTS: The article concludes that rationing is least defensible at the clinical level, where it is also most covert. The role of rationing at other levels is more defensible when based on grounds of cost-effectiveness rather than equity. The article emphasizes the importance of fairness in health allocation and suggests that efficiency criteria need to be considered in that context. DISCUSSION: The article suggests that rationing is most problematic where it is least overt. This raises further questions about how rationing can be made more explicit at different levels of decision making.

Age Factors↗
PubMed2001

The future of capitation: the physician role in managing change in practice.

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.

Capitation Fee↗
PubMed1990

The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

Black or African American↗
PubMed2006

Simulating the pattern of right-hemisphere-damaged patients for the processing of the alternative metaphorical meanings of words: evidence in favor of a cognitive resources hypothesis.

Lately, many studies have suggested that communication impairments in brain-damaged individuals might be explained--at least in part--in terms of cognitive resource allocation. Reproducing a clinical pattern in normal subjects by using a dual-task treatment might be a way of evaluating the role of cognitive resources in the right hemisphere's contribution to verbal communication. This study suggests that the RH's presumed specific contribution to the processing of the alternative metaphorical meanings of words is, at least to some extent, the expression of the RH's complementary, and necessary, contribution to the pool of attentional resources needed for the most effortful processing.

Aged↗
PubMed2006

Joint project of the international network of agencies for health technology assessment--Part 1: Survey results on diffusion, assessment, and clinical use of positron emission tomography.

OBJECTIVES: The International Network of Agencies for Health Technology Assessment (INAHTA) has been tracking activities associated with the clinical use of positron emission tomography (PET) in its members' healthcare systems since 1997 and published its first Joint Project report on PET in 1999. Part 1 of this Joint Project report presents survey results on diffusion, assessment activities, and policy for clinical use related to PET among INAHTA members since 1999. METHODS: INAHTA members were surveyed in 2003-2004. RESULTS: Twenty-seven INAHTA agencies (69 percent response rate) from nineteen countries responded to the survey. Dedicated PET systems are the most universally installed systems to date. Mobile scanners and modified gamma cameras are used occasionally as lower cost alternatives, and interest in PET-computed tomography hybrid models is rising despite limited assessment of impact on service planning. PET was used and assessed most commonly for managing patients with cancer. All respondents reported having some form of public funding for clinical PET frequently linked to data collection for the purpose of gathering evidence to refine clinical use and guide resource allocation toward indications that maximize clinical and cost-effectiveness. CONCLUSIONS: The use of HTA within a continuous quality improvement framework can help optimize scarce resources for evaluation and use of high cost diagnostic technologies such as PET, particularly where potential clinical or cost-effectiveness is considerable but conclusive evidence is lacking.

Diffusion of Innovation↗
PubMed2003

Lifetime resource utilization, flight physiology, and the evolution of contest competition in territorial insects.

Adaptationist analyses of animal contests have contributed much to our understanding of behavioral evolution. One class of contest, however, the war of attrition, has proven difficult to interpret. In wars of attrition involving aerial displays, there is evidence that asymmetries in performance parameters such as flight energetics may be important determinants of contest resolution. This paradigm is not universal, however, and we presently lack a framework for understanding why certain biophysical parameters are important only in some cases. One possibility is that the relevance of these parameters is determined by evolutionarily conserved life-history-scale patterns of resource allocation and acquisition. We evaluated this hypothesis by investigating the correlates of competitive success in two territorial insects that exemplify markedly different lifetime patterns of resource utilization. We found that in the bot fly Cuterebra austeni, an extreme capital breeding species that depends entirely on energy acquired during its immature stages, territorial residency was most strongly correlated with a size-independent measure of energetic availability. In contrast, residency in the tarantula hawk wasp Hemipepsis ustulata was best predicted by variation in body size per se. Adult H. ustulata are able to supplement their larval-derived nutrient capital in the manner of an income breeder, and fuel reserves were independent of age and actually correlated negatively with residency in this species. These results underscore how the study of sexually selected phenomena may be enriched by an explicit consideration of life-history principles.

Animals↗
PubMed1975

Revenue allocation in the reorganized Health Service.

This paper recommends that the secrecy long associated with the allocation of Health Service revenue should be replaced by an objective formula applied to areas and districts. In this way the allocations should be "fairer" and the different tiers of management within the reorganized N.H.S. would have a greater incentive for the better use of their resources. The Department of Health and Social Security has demonstrated its desire to be frank and objective in revenue resource allocation and it new remains for the other tiers to follow suit.

Financing, Government↗
PubMed2003

Management commitment to safety and health in residential construction: HomeSafe spending trends 1991-1999.

The support of good management is fundamental to the success of any safety and health program. Residential construction is a high-risk industry requiring significant commitment by management to impact day-to-day safety and health challenges. Investigators have evaluated management practices and spending trends in a cohort of 228 residential homebuilders in the Denver metro area of Colorado. Findings suggest that companies significantly increased dollars allocated to support safety and health practices between 1991 and 1999. In addition, the HomeSafe Pilot Program has positively impacted financial commitments of partner companies. Resource allocations were significantly greater for specific expense categories when comparing pre to post HomeSafe intervention. This paper presents data on the use of written safety and health programs, safety committees, and workers compensation premium cost containment certification, as well as allocations to safety incentive programs (SIP), personal protective equipment (PPE), other safety equipment (OSE), and safety training (ST).

Accidents, Occupational↗
PubMed1992

Drug discovery and development in the pharmaceutical industry.

The discovery and development of new anticancer drugs is a complex and largely empirical process. New compounds can be discovered by screening, modification of existing compounds, rational drug design, and serendipitous basic research observations. Selection of compounds for clinical trials depends on assays of uncertain predictive value. In the pharmaceutical industry, priorities for development of potentially active entities are set and available resources allocated based on the availability and cost of supplies, patent status, potential spectrum of activity, ability to meet regulatory requirements, and market assessments. Competition for resources also occurs from noncancer drugs, eg, cardiovascular agents. Clinical development (testing and approval for commercial distribution) requires close attention to the requirements of national regulatory agencies such as the United States Food and Drug Administration. The arbitrary nature by which compounds with antitumor potential are chosen for development means that some that would be useful never reach clinical trial and others are never made generally available. This article reviews the decision making process in the pharmaceutical industry by which compounds are identified and selected for clinical trial, the regulations in the United States that govern such trials, and what is required to have the drug approved for commercial distribution.

Animals↗
PubMed2002

[Patient referral and patient volume in a regional hospital].

BACKGROUND: A general trend in health care is the increasing discrepancy between resources available and the volume of patients treated. Few studies have looked at a reduction in patient referral as a possible explanation for this situation. MATERIAL AND METHODS: The volume of hospital admissions and outpatient care 1996 through 2000 at a large regional hospital was related to the number of referrals over the same period. RESULTS: There was an overall increase in patient admissions as well as in outpatient care during the study period. However, while the number of new referrals seen as outpatients dropped by 1.2%, the number of patients in for controls increased by 27.1%. While some departments had an increase in both admissions and new outpatients, other departments had a dramatic decrease in new patient contacts but total patient volume was maintained by a comparable increase in control consultations. At the same time, there was a 15.1% overall drop in new patient referrals (new referrals for admissions down 44.4%, new referrals for outpatient care down 11.4%), in some departments even more. INTERPRETATION: The study shows that patient demand for hospital care is not unlimited and should also be considered when more resources allocated to hospitals do not result in increased patient volume.

Bed Occupancy↗
PubMed1999

The development of radiology guidelines in Canada, Part 2.

In the second part of a two-part article on the development of Canadian clinical practice guidelines in radiology, the author discusses the implementation of guidelines. The aim is to translate guidelines into practice policies, but nation-wide implementation is difficult because of the regional circumstances and constraints in Canadian health care. One approach to making guidelines more effective tools and preventing conflict is to distinguish between effectiveness (benefit of an intervention under average conditions of use) and efficiency (value of an intervention compared with other things that could be done with the same resources). Clinical practice guidelines are based on effectiveness criteria alone, whereas practice policies can be based on efficiency criteria and are made by those responsible for allocating resources. From an ethical point of view, guidelines have an important feature in common with applied ethics: neither can give the right answer in a situation, but both can indicate the right decision-making process, including who should decide, on what basis, using which process and for what purpose. From a legal standpoint, if the medical community views guidelines as constituting reasonable medical care and jurists see them as a medical and legal norm, they can have significant influence in malpractice litigation. At the last annual meeting of the CAR, the executive committee decided that an integrated national approach to guidelines is needed because of the considerable confusion in this field. It supports the National Framework Development Committee's efforts to set national principles and operating rules for development and implementation. This necessitates an organizational structure consisting of a coordinating group representing consumers, service providers, regulators and funding agencies; multidisciplinary guidelines-development groups; and methodology resource groups.

Canada↗
PubMed1996

Resourcing decision model for military hospitals.

As military medicine continues its adoption of managed care economic principles, the leadership of our military treatment facilities (MTFs) need a clear and simple rationale for making resource allocation decisions. The leadership body of an MTF needs to be cognizant of the role of readiness when making such decisions. This article provides a simple resourcing decision model that includes "readiness" as a decision-making factor.

Cost-Benefit Analysis↗
PubMed1994

A population-based study of the association of medical manpower with county trauma death rates in the United States.

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed2000

Curricular change in medical schools: how to succeed.

Society's changing needs, advancing knowledge, and innovations in education require constant changes of medical school curricula. But successful curricular change occurs only through the dedicated efforts of effective change agents. This study systematically searched and synthesized the literature on educational curricular change (at all levels of instruction), as well as organizational change, to provide guidance for those who direct curricular change initiatives in medical schools. The focus was on the process of planning, implementing, and institutionalizing curricular change efforts; thus, only those articles that dealt with examining the change process and articulating the factors that promote or inhibit change efforts were included. In spite of the highly diverse literature reviewed, a consistent set of characteristics emerged as being associated with successful curricular change. The frequent reappearance of the same characteristics in the varied fields and settings suggests they are robust contributors to successful change. Specifically, the characteristics are in the areas of the organization's mission and goals, history of change in the organization, politics (internal networking, resource allocation, relationship with the external environment), organizational structure, need for change, scope and complexity of the innovation, cooperative climate, participation by the organization's members, communication, human resource development (training, incorporating new members, reward structure), evaluation, performance dip (i.e., the temporary decrease in an organization's performance as a new program is implemented), and leadership. These characteristics are discussed in detail and related specifically to curricular change in medical school settings.

Communication↗
PubMed1980

An approach to the analysis of health care needs and resources.

A semi-quantitative method of analysing the relationship between health care resources and need is described. It utilises the Donabedian model which expresses needs and resources in equivalent units in order to estimate the ratio of resources to need. The optimum resource/need ratio is regarded as that pertaining to the reference population; deviation from this optimum ratio in the subunits of the reference population is interpreted as a manifestation of inequitable resource distribution. An example is presented of the application of the method to the Greater Glasgow Health Board and its five constituent districts for the years 1974-77. It is argued that this method might, without undermining the principle of geographical equity, meet some of the objections to the more rigid 'formula' approach in the report of the Resource Allocation Working Party (RAWP) and in the Scottish Health Authorities Revenue Equalisation (SHARE) report.

Health Resources↗
PubMed1994

Devolved clinical management and casemix.

Devolved clinical management aims at greater medical and nursing involvement in the management of health resources and focuses on achieving measurable improvements in patient care through better use of resources. It permits the major drivers of the health care system (doctors), in collaboration with the major direct care providers (nurses), to be not only effective at allocating resources but also effective resource users. Casemix is a classification of patient care episodes based principally on resource use and can assist in the process of managing health services. We discuss the relationship between devolved clinical management and casemix systems. Health care organisations must move towards devolved clinical management, with a greater focus on the patient and a greater emphasis on accountability among all clinical disciplines.

Australia↗
PubMed1991

Assessment of the effectiveness of supply-side cost-containment measures.

This article assesses the arguments and evidence concerning the likely effectiveness of four supply-side cost-containment measures. The health planning efforts of the 1970s, particularly certificate-of-need regulations, had very limited success in containing costs. The new and related tools of technology assessment and practice guidelines hold some promise for refining benefit packages, but they are inadequate for micromanaging complex medical practices. Payment policies, such as hospital ratesetting, have enjoyed some success in limiting hospital cost growth but are less effective at controlling total costs. None of these measures alone is likely to address fully the fundamental issues of equity and efficiency in health care resource allocation that underlie the problem of rising costs.

Clinical Protocols↗
PubMedDate not supplied

Calculating and updating nursing turnover costs.

A detailed study allowed FY 1988 nursing turnover costs to be calculated at four southeastern hospitals. These turnover costs were later updated using a procedure incorporating Consumer Price Index information. This procedure allows nurse administrators to determine and update turnover costs, to accurately evaluate the impact of nursing turnover, and to facilitate resource allocation.

Costs and Cost Analysis↗