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PubMed1999

Ratio-based and net benefit-based approaches to health care resource allocation: proofs of optimality and equivalence.

Both incremental cost-effectiveness ratios and net benefits have been proposed as summary measures for use in cost-effectiveness analyses. We present a unifying proof of the optimality and equivalence of ICER- and net benefit-based approaches to the health resource allocation problem, including both 'fixed budget' and 'fixed price' decision rules. If internally consistent willingness-to-pay values are used, ratio- and net benefit-based decision rules identify the same optimal allocation. Because they have identical resource allocation implications, use of one or other of the two approaches must be based on other criteria, such as their behaviour under conditions of uncertainty.

Cost-Benefit Analysis↗
PubMed1995

A quantitative approach to quality improvement and resource allocation.

This report illustrates ways in which routinely collected hospital morbidity data can be used to inform and improve decisions about resource allocation, priorities for services and opportunities for improvement. All hospitals, public and private, Australia-wide collect these data at enormous expense. The resources allocated to processing, analysing and utilizing the data are minimal by comparison. Used appropriately these data can provide valuable information to managers and clinicians alike.

Australia↗
PubMed2002

Resource allocation to prevent trachomatous low vision among older individuals in rural areas of less developed countries.

Trachomatous low vision can be prevented by treating or preventing infection or through surgery to treat trichiasis. Resource allocation to prevent trachomatous low vision should be directed to those interventions that are the most cost-effective. In order to assess which of many potential interventions are the more cost-effective, data on the epidemiology of the disease, the effectiveness of community- and facility-based interventions, and the cost of the interventions are required. This paper provides a stylized model of the path from risk of infection through disease to trachomatous low vision or blindness that delineates the points at which interventions may occur and for which data are required. The literature reveals a considerable amount of data regarding the epidemiology of the trachoma and its sequelae but little on the effectiveness of community-based interventions and only one study that measured costs directly. More data are needed to assist policy makers and international program partners who seek to make efficient resource allocation decisions in an effort to eliminate trachoma as a cause of incident blindness in the developing countries in which trachomatous blindness remains prevalent.

Anti-Bacterial Agents↗
PubMed2004

Resource allocation and somatosensory P300 amplitude during dual task: effects of tracking speed and predictability of tracking direction.

OBJECTIVE: The amount of attentional resources allocated to a task is determined by the intrinsic demands, also denoted as task load or difficulty of the task. Effects of resource allocation on the somatosensory N140 and P300 were investigated in an inter-modal situation using a dual-task methodology. METHODS: Under a dual-task condition, subjects concurrently performed a visuomotor tracking task and a somatosensory oddball task, while they performed just the oddball task under an oddball-only condition. In the tracking task, the subjects tracked the target line, which was presented on an oscilloscope and automatically moved, with the line which represented their own force generated by grip movement with the left hand. Tracking speed (experiment 1) and tracking predictability (experiment 2) were manipulated to vary task difficulty. N140, P300, and reaction time (RT) in the oddball task and tracking accuracy in the tracking task were measured. RESULTS: The P300 and N140 amplitudes were reduced in the dual-task condition compared to those in the oddball-only condition. The fastest tracking speed produced lower tracking accuracy and later RT. However, the tracking speed did not affect the P300 or N140 amplitudes. In contrast, the P300 amplitude was smaller when the change in tracking direction was unpredictable than when it was predictable, without any differences in tracking accuracy or RT, N140. CONCLUSIONS: The differences in behaviors among N140, P300, and RT following manipulation of task difficulty support the multiple-resource hypothesis, which defines functionally separate pools of resources. SIGNIFICANCE: The present study may show that the P300 amplitude reflects modality-unspecific resource at more central level, and that the N140 amplitude involves perceptual resource.

Adult↗
PubMed1975

REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic.

The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.

Contraceptives, Oral↗
PubMed2004

Plasticity in resource allocation based life history traits in the Pacific oyster, Crassostrea gigas. I. Spatial variation in food abundance.

We investigated the quantitative genetics of plasticity in resource allocation between survival, growth and reproductive effort in Crassostrea gigas when food abundance varies spatially. Resource allocation shifted from survival to growth and reproductive effort as food abundance increased. An optimality model suggests that this plastic shift may be adaptive. Reproductive effort plasticity and mean survival were highly heritable, whereas for growth, both mean and plasticity had low heritability. The genetic correlations between reproductive effort and both survival and growth were negative in poor treatments, suggesting trade-offs, but positive in rich ones. These sign reversals may reflect genetic variability in resource acquisition, which would only be expressed when food is abundant. Finally, we found positive genetic correlations between reproductive effort plasticity and both growth and survival means. The latter may reflect adaptation of C. gigas to differential sensitivity of fitness to survival, such that genetic variability in survival mean might support genetic variability in reproductive effort plasticity.

Adaptation, Physiological↗
PubMed2003

Aging, memory load, and resource allocation during reading.

To test the notion that aging brings an inability to self-initiate processing, the authors investigated the effects of memory load on online sentence understanding. Younger and older adults read a series of short passages with or without a simultaneous updating task, which would be expected to deplete resources by consuming memory capacity. Regression analyses of word-by-word reading times onto text variables within each condition were used to decompose reading times into resources allocated to the array of word-level and textbase-level processes needed for comprehension. Among neither the young nor the old were word-level processes disrupted by a simultaneous memory load. However, older readers showed relatively greater levels of resource allocation to conceptual integration than the younger adults when under load, regardless of working-memory span or task priority. These results suggest that the ability to self-initiate the allocation of processing resources during reading is preserved among older readers.

Adolescent↗
PubMed1978

Changing patterns of resource allocation in a London teaching district.

The health plans of the Tower Hamlets district management team were studied to determine what effects the report of the Resource Allocation Working Party and the White Paper "Priorities in the Health and Social Services" have had on resource allocation in a teaching district. The study showed that at present acute services are allocated a greater proportion of the district budget than occurs nationally, while geriatrics, mental health, and community services receive proportionately less. In the next three years spending on acute services is expected to decrease, while spending on geriatric facilities and community services will increase. Nevertheless, cuts in acute services will take place mainly through a reduction in the number of beds serving a community function, concentrating all acute services in the teaching hospital. Services to the district might be better maintained by creating a community hospital to meet the needs of patients who would otherwise need to be accommodated in acute beds with unnecessarily expensive support services.

Community Health Services↗
PubMed2005

Axioms for health care resource allocation.

This paper examines principles of health care resource allocation based on axioms for individual preferences and distributive justice. We establish axioms for representing individual preferences by quality-adjusted life years (QALYs), as well as axioms for existence of a social welfare function depending only on QALYs. A symmetric Cobb-Douglas social welfare function is characterized by an axiom stating that social welfare is anonymous with respect to the distribution of individual life years. Replacing this axiom with an axiom of non-age dependence, we obtain a characterization of a utilitarian social welfare function with certain weights. Further, we give axioms for a social welfare function being a weighted sum of power transformations of individual QALYs.

Consumer Behavior↗
PubMed2004

Accommodating health and social care needs: routine resource allocation in stroke rehabilitation.

This paper explores routine resource allocation processes in health and social care. While there has been a small body of work which has drawn on Lipsky's (1980) insights into street level bureaucracy, few have taken seriously the opportunity offered by ethnography to explore in detail the work of front-line staff as a way of observing policy processes in action. Utilising ethnographic data from research into the continuing care of adults who had suffered a first acute stroke, we analyse how staff accommodated patient need and consider the implications that this had for the quality, equality and equity of service provision.

Aged↗
PubMed1998

Resource allocation and resident outcomes in nursing homes: comparisons between the best and worst.

The purpose of this study was to identify patterns of resource allocation that relate to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, case mix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of registered nurse (RN) staffing and higher costs. However, comparison groups based on best-worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high- and low-cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes.

Aged↗
PubMed1999

Using clinical indicators in emergency medicine: documenting performance improvements to justify increased resource allocation.

OBJECTIVES: To demonstrate how emergency department triage scale and thrombolysis indicator data can be used to document the impact of a substantial increase in resource allocation. METHODS: Descriptive study in an emergency department of an adult tertiary hospital in Perth, Australia during similar periods of the year both before and after a substantial increase in emergency department staff, equipment, and system resources. The study group comprised a total of 11,048 emergency department attendances and all cases of emergency department initiated thrombolysis or acute angioplasty. Outcome was measured using numbers seen and percentage seen within indicator threshold time together with admission rates in each of the five triage categories as well as by using time from presentation to initiation of reperfusion treatment in acute myocardial infarction. RESULTS: The proportion of patients seen within the prescribed indicator time increased by 16.4% (95% confidence interval 14.4% to 18.2%). The increase was most pronounced in triage category 2 (32.7%). Median time to thrombolysis fell by 30 minutes to 37 minutes (p = 0.0002). CONCLUSIONS: Use of the Australasian national triage scale and time to thrombolysis clinical indicator data allows a quantitative assessment of the impact of increased emergency department resource allocation.

Adult↗
PubMed2002

Optimal resource allocation for curing Chlamydia trachomatis infection among asymptomatic women at clinics operating on a fixed budget.

GOAL: The goal was to determine the optimal strategy for screening coverage, test selection, and treatment for infection in asymptomatic women for a given family-planning-program budget. STUDY DESIGN: We developed a resource allocation model to determine the optimal strategy using data from 5078 visits by women universally screened for infection in a publicly funded family planning clinic system in Philadelphia. We maximized the number of infected women cured from the clinic perspective and maximized the cost-savings from the healthcare system perspective. The model incorporated the following age distributions: <20 years (27%), 20 to 24 years (30%), and >24 years (43%), with prevalences of 10.6%, 6.9%, and 2.3%, respectively. We modeled two screening test assays (DNA probe and ligase chain reaction [LCR] for cervical specimens) and two treatments (doxycycline and azithromycin). The model allowed for different test and treatment choices by age group. RESULTS: At the baseline annual budget of $6 per visit, the strategy that maximized both the number of infected women cured and cost savings would be to screen all women with DNA probe and to treat all women with positive tests with azithromycin. This strategy would result in 183 women cured at a cost-savings of $140,176. Sensitivity analysis showed that the total budget had a great impact on the optimal strategy, incorporating screening coverage, test selection, and treatment. CONCLUSIONS: Using resource allocation models enables clinic managers operating with a fixed budget to identify a strategy that maximizes the number of asymptomatic women cured and cost savings when the clinic age distribution and age-specific prevalences are known.

Ambulatory Care Facilities↗
PubMed2003

Understanding the role of "the hidden curriculum" in resource allocation--the case of the UK NHS.

In this paper we want to briefly illustrate the ways in which technical, ethical and political judgements of various kinds are interwoven in the processes of healthcare decision-making in the UK. Drawing upon the research for the "Choices in Health Care" project we will borrow the notion of the hidden curriculum from education to illuminate the nature of resource allocation decision processes. In particular we will indicate some of the fundamental but largely hidden political factors in play in these processes and the importance of the inchoate and implicit notion of "NHS values" in shaping UK resource allocation policies. We suggest that these more diffuse, holistic and system level value judgements are both central to understanding priority setting and at the same time difficult to reduce or abstract out into lists of single values/principles.

Costs and Cost Analysis↗
PubMed2000

Modelling of resource allocation to health care authorities in Stockholm county.

Since the Stockholm County Council introduced a system of purchasers and providers there has been a quest for population-based resource allocation models to allocate monies to purchasers of health care. In contrast to models used in Britain, Swedish models have been based on individual level data. This paper presents recent developments in the model used in Stockholm for all care except primary care, testing new statistical methods for compression and clustering of the matrices used and the effect of introducing diagnostic information in addition to the demographic and socio-economic information used before. We also show the effect of using more current data sources by replacing existing census variables with data from annually updated registers. Since the aim is to use the resource allocation models for prospective budgeting we test and evaluate the predictive power of the models one to two years ahead. Moreover, two calibration methods are compared: Cross-sectional modelling, based on data for one year only, versus prospective modelling, using population characteristics for one year and registered health-care costs for a following year. While models including diagnostic information are deemed valuable, the prospective models yield little improvement. Further, although it takes a combination of new variables to replace the census based model, the resulting model now implemented by Stockholm County Council has fewer estimated parameters.

Adolescent↗
PubMed2005

Alcoholism: Illness beliefs and resource allocation preferences of the public.

BACKGROUND: Alcohol-dependent patients are at risk of being denied necessary care because of their diagnosis. We sought to find out whether public illness beliefs influence resource allocation decisions of the public, thus putting alcohol-dependent patients at a disadvantage compared to those suffering from other medical and mental disorders. METHOD: A telephone survey involving the adult German population was conducted in 2004 (n = 1012). Participants were asked to name three out of nine conditions for which they would prefer resources not to be cut should general cutbacks within the health care budget be necessary. For all conditions we asked about personal attitudes and illness beliefs. RESULTS: Schizophrenia and alcoholism were chosen least frequently when it was a question of being spared from budget reductions. Compared to other diseases, alcoholism was considered to be particularly self-inflicted and evoked a high desire for social distance. The perceived severity of the disease, the perceived own risk of becoming alcohol dependent, and the notion that alcoholics are themselves responsible for their illness were associated with resource allocation decisions. CONCLUSION: Alcohol-dependent patients are at risk of being structurally discriminated within the health care system.

Adolescent↗
PubMed1998

Estimation of direct cost and resource allocation in intensive care: correlation with Omega system.

OBJECTIVE: An instrument able to estimate the direct costs of stays in Intensive Care Units (ICUs) simply would be very useful for resource allocation inside a hospital, through a global budget system. The aim of this study was to propose such a tool. DESIGN: Since 1991, a region-wide common data base has collected standard data of intensive care such as the Omega Score, Simplified Acute Physiologic Score, length of stay, length of ventilation, main diagnosis and procedures. The Omega Score, developed in France in 1986 and proved to be related to the workload, was recorded on each patient of the study. SETTING: Eighteen ICUs of Assistance Publique-Hôpitaux de Paris (AP-HP) and suburbs. PATIENTS: 1) Hundred twenty-one randomly selected ICU patients; 2) 12,000 consecutive ICU stays collected in the common data base in 1993. MEASUREMENTS: 1) On the sample of 121 patients, medical expenditure and nursing time associated with interventions were measured through a prospective study. The correlation between Omega points and direct costs was calculated, and regression equations were applied to the 12,000 stays of the data base, leading to estimated costs. 2) From the analytic accounting of AP-HP, the mean direct cost per stay and per unit was calculated, and compared with the mean associated Omega score from the data base. In both methods a comparison of actual and estimated costs was made. RESULTS: The Omega Score is strongly correlated to total direct costs, medical direct costs and nursing requirements. This correlation is observed both in the random sample of 121 stays and on the data base' stays. The discrepancy of estimated costs through Omega Score and actual costs may result from drugs, blood product underestimation and therapeutic procedures not involved in the Omega Score. CONCLUSIONS: The Omega system appears to be a simple and relevant indicator with which to estimate the direct costs of each stay, and then to organise nursing requirements and resource allocation.

Critical Care↗