Resource Allocation Dilemmas in Large Federal Healthcare Systems

2001 ◽  
pp. 236-259
Author(s):  
W. Paul Kearns ◽  
Julie Hall ◽  
W. Todd Grams ◽  
Gina Barhoumy
Keyword(s):  
Resource Allocation ◽  
Healthcare Systems

scholarly journals Vulnerability identified in clinical practice: a qualitative analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Laura Sossauer ◽  
Mélinée Schindler ◽  
Samia Hurst
Keyword(s):  
Resource Allocation ◽  
Clinical Practice ◽  
Personal Characteristics ◽  
Healthcare Systems ◽  
Single Factor ◽  
Pragmatic Approach ◽  
Compensation Systems ◽  
Vulnerable Patients ◽  
Principal Factors ◽  
Definition Of

Abstract Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems.

scholarly journals Addressing prioritization in healthcare amidst a global pandemic

2021 ◽  
pp. 084047042110025
Author(s):  
Craig Mitton ◽  
Cam Donaldson ◽  
Francois Dionne ◽  
Stuart Peacock
Keyword(s):  
Resource Allocation ◽  
Priority Setting ◽  
Healthcare Systems ◽  
Decision Makers ◽  
Ethical Principles ◽  
Choice Making ◽  
Early Stages ◽  
Global Pandemic ◽  
Trade Offs ◽  
Second Wave

Trade-offs abound in healthcare yet depending on where one stands relative to the stages of a pandemic, choice making may be more or less constrained. During the early stages of COVID-19 when there was much uncertainty, healthcare systems faced greater constraints and focused on the singular criterion of “flattening the curve.” As COVID-19 progressed and the first wave diminished (relatively speaking depending on the jurisdiction), more opportunities presented for making explicit choices between COVID and non-COVID patients. Then, as the second wave surged, again decision makers were more constrained even as more information and greater understanding developed. Moving out of the pandemic to recovery, choice making becomes paramount as there are no set rules to lean back into historical patterns of resource allocation. In fact, the opportunity at hand, when using explicit tools for priority setting based on economic and ethical principles, is significant.

scholarly journals Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Brayan V. Seixas ◽  
François Dionne ◽  
Craig Mitton
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Priority Setting ◽  
Stakeholder Involvement ◽  
Healthcare Systems ◽  
High Income ◽  
Narrative Synthesis ◽  
Value Assessment ◽  
Screening Process ◽  
Scoping Literature Review

Abstract Background Due to growing expenditures, health systems have been pushed to improve decision-making practices on resource allocation. This study aimed to identify which practices of priority setting and resource allocation (PSRA) have been used in healthcare systems of high-income countries. Methods A scoping literature review (2007–2019) was conducted to map empirical PSRA activities. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. That was complemented with a gray literature and horizontal scanning. A narrative synthesis was carried out to make sense of the existing literature and current state of PSRA practices in healthcare. Results One thousand five hundred eighty five references were found in the peer-reviewed literature and 25 papers were selected for full-review. We identified three major types of decision-making framework in PSRA: 1) Program Budgeting and Marginal Analysis (PBMA); 2) Health Technology Assessment (HTA); and 3) Multiple-criteria value assessment. Our narrative synthesis indicates these formal frameworks of priority setting and resource allocation have been mostly implemented in episodic exercises with poor follow-up and evaluation. There seems to be growing interest for explicit robust rationales and ample stakeholder involvement, but that has not been the norm in the process of allocating resources within healthcare systems of high-income countries. Conclusions No single dominate framework for PSRA appeared as the preferred approach across jurisdictions, but common elements exist both in terms of process and structure. Decision-makers worldwide can draw on our work in designing and implementing PSRA processes in their contexts.

Healthcare Resource Allocation and Priority-setting. A European Challenge

2020 ◽  
Vol 27 (2) ◽  
pp. 93-114 ◽  
Author(s):  
Caterina Di Costanzo
Keyword(s):  
Resource Allocation ◽  
Priority Setting ◽  
Healthcare Resource ◽  
Healthcare Systems ◽  
Progressive Increase ◽  
Healthcare Resources ◽  
Scarce Resources ◽  
Total Budget ◽  
Important Health ◽  
The Right

Abstract The right to health, as a right to healthcare, represents the most expensive social right in Europe, significantly affecting the total budget of the Member States, both in universal and insurance healthcare systems. No healthcare system provides unlimited healthcare resources to all its users. The resources available for healthcare are limited compared with demand, and all healthcare systems, regardless of their financing and organisation, employ mechanisms to prioritise finite healthcare resources. The progressive increase in healthcare costs in a context of scarce resources, worsened by the fiscal crisis of the 1990s and economic crises spreading in Europe since 2007, has highlighted the ever more urgent need to address the fundamental issues of resource allocation and priority-setting at both European and national levels. Hence, priority-setting is arguably one of the most important health policy issues of our time at global, European and national levels.

scholarly journals When Demand Outstrips Supply: A Christian View of the Ethics of Healthcare Resource Allocation During the COVID-19 Pandemic

2020 ◽  
Vol 7 (1) ◽  
pp. 13-19
Author(s):  
James Haslam ◽  
Melody Redman
Keyword(s):  
Resource Allocation ◽  
Healthcare Resource ◽  
Healthcare Systems ◽  
Christian Ethics ◽  
Ethical Guidelines ◽  
High Demand ◽  
Healthcare Resources ◽  
Christian View ◽  
Healthcare Resource Allocation

The coronavirus (COVID-19) pandemic presents the greatest challenge to global healthcare systems in living memory. This article deals with the ethics of rationing the supply of scarce healthcare resources, such as ventilators, during periods of high demand, such as the current pandemic. Existing ethical guidelines and commentaries are cited and critiqued from a Christian ethics viewpoint.

Folk-economic beliefs as moral intuitions

2018 ◽  
Vol 41 ◽  
Author(s):  
Neil Malhotra
Keyword(s):  
Resource Allocation ◽  
Moral Intuitions ◽  
Economic Beliefs ◽  
Evolutionary Explanations

AbstractAlthough Boyer & Petersen's (B&P's) cataloguing of and evolutionary explanations for folk-economic beliefs is important and valuable, the authors fail to connect their theories to existing explanations for why people do not think like economists. For instance, people often have moral intuitions akin to principles of fairness and justice that conflict with utilitarian approaches to resource allocation.

Toward Identifying Mild Cognitive Impairment in Hispanic and African American Adults

2017 ◽  
Vol 2 (2) ◽  
pp. 110-116
Author(s):  
Valarie B. Fleming ◽  
Joyce L. Harris
Keyword(s):  
Older Adults ◽  
African American ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Healthcare Access ◽  
Communication Disorders ◽  
Healthcare Systems ◽  
Prevention Education ◽  
Education Management ◽  
African American Adults

Across the breadth of acquired neurogenic communication disorders, mild cognitive impairment (MCI) may go undetected, underreported, and untreated. In addition to stigma and distrust of healthcare systems, other barriers contribute to decreased identification, healthcare access, and service utilization for Hispanic and African American adults with MCI. Speech-language pathologists (SLPs) have significant roles in prevention, education, management, and support of older adults, the population must susceptible to MCI.

Mother or Wife?

2012 ◽  
Vol 43 (4) ◽  
pp. 232-242 ◽  
Author(s):  
Phia S. Salter ◽  
Glenn Adams
Keyword(s):  
United States ◽  
Resource Allocation ◽  
Cultural Psychology ◽  
The United States ◽  
Personal Relationship ◽  
Three Dimensions ◽  
Church Membership ◽  
Cultural Dynamics ◽  
Psychology Perspective ◽  
Cultural Ecological

Inspired by “Mother or Wife” African dilemma tales, the present research utilizes a cultural psychology perspective to explore the dynamic, mutual constitution of personal relationship tendencies and cultural-ecological affordances for neoliberal subjectivity and abstracted independence. We administered a resource allocation task in Ghana and the United States to assess the prioritization of conjugal/nuclear relationships over consanguine/kin relationships along three dimensions of sociocultural variation: nation (American and Ghanaian), residence (urban and rural), and church membership (Pentecostal Charismatic and Traditional Western Mission). Results show that tendencies to prioritize nuclear over kin relationships – especially spouses over parents – were greater among participants in the first compared to the second of each pair. Discussion considers issues for a cultural psychology of cultural dynamics.

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