Resource Allocation in a National Dental Service Using Program Budgeting Marginal Analysis

Introduction: In any health system, choices must be made about the allocation of resources (budget), which are often scarce. Economics has defined frameworks to aid resource allocation, and program budgeting marginal analysis (PBMA) is one such framework. In principle, patient and public values can be incorporated into these frameworks, using techniques such as willingness to pay (WTP). However, this has not been done before, and few formal resource allocation processes have been undertaken in dentistry. This study aimed to undertake a PBMA with embedded WTP values in a national dental setting. Methods: The PBMA process was undertaken by a panel of participant-researchers representing commissioners, dentists, dental public health staff, and academics. The panel reviewed current allocations and generated a set of weighted criteria to evaluate services against. Services to be considered for removal and investment were determined by the panel and wider discussion and then scored against the criteria. Values from a nationally representative WTP survey of the public contributed to the scores for interventions. Final decisions on removal and investment were taken after panel discussion using individual anonymous electronic voting. Results: The PBMA process resulted in recommendations to invest in new program components to improve access to general dentists, care home dentistry, and extra support for dental public health input into local government decisions. Disinvestments were recommended in orthodontics and to remove routine scaling and polishing of teeth. Discussion: The PBMA process was successful in raising awareness of resource allocation issues. Implementation of findings will depend on the ability of decision makers to find ways of operationalizing the decisions. The process illustrates practical aspects of the process that future dental PBMAs could learn from. Knowledge Transfer Statement: This study illustrates a framework for resource allocation in dental health services and will aid decision makers in implementing their own resource allocation systems.

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Working towards evidence-informed policy: Public health report Stockholm

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1224 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Bartelink ◽

D Yacaman Mendez ◽

A Lager

Keyword(s):

Public Health ◽

Resource Allocation ◽

Scientific Literature ◽

Decision Makers ◽

High Quality ◽

Public Health Report ◽

The Public ◽

Health Report ◽

High Quality Evidence ◽

Quality Evidence

Abstract Issue Public health problems and interventions are often addressed in sub-optimal ways by not prioritizing them based on the best available evidence. Description of the Problem The public health report 2019 for the Stockholm region aims to inform decision makers, politicians, and public health workers about the risk factors and diseases that account for the biggest part of the burden of disease with a clear focus on high quality evidence and communication of main messages. How did the public health report 2019 affect public health policy in the Stockholm region? Results The public health report 2019 influenced agenda setting, resource allocation and priority setting in the Stockholm region. Lessons We identified the following facilitating factors in the process, of which most also are supported in scientific literature, in chronological order: 1) understanding the policymaking context to be aware of windows of opportunity, 2) establishing relationships with relevant policymakers, engage with them routinely in the decision-making process, and being accessible for questions, 3) doing high-quality research by considering the latest scientific literature, multiple data sources and involving academic experts in the field, 4) communicating clear and relevant messages for generalists by translating research into easy-understandable texts and attractive figures, and 5) active dissemination of the report through multiple channels. In addition, the following barriers were identified: 1) the timeframe of the policymaking process was not in line with the research process, and 2) involving politicians in an early stage can potentially harm the objectivity of research in media messages. Key messages By focussing on major problems, high quality evidence and clear messages a public health report can contribute to more evidence-informed policy making. Engaging decision makers in the process of public health reporting is critical for the impact on agenda setting, resource allocation, and priority setting.

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Linn County Dental Health Center-A Successful Dental Public Health Access Program of Treatment and Prevention

Journal of Public Health Dentistry ◽

10.1111/j.1752-7325.1983.tb01891.x ◽

1983 ◽

Vol 43 (2) ◽

pp. 139-144 ◽

Cited By ~ 2

Author(s):

Rhys B. Jones

Keyword(s):

Public Health ◽

Health Center ◽

Dental Health ◽

Health Access ◽

Dental Public Health ◽

Treatment And Prevention ◽

Linn County ◽

Access Program

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Geriatric oral health concerns, a dental public health narrative

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20185509 ◽

2019 ◽

Vol 6 (2) ◽

pp. 883

Author(s):

Ramprasad Vasthare ◽

Anil V. Ankola ◽

Arron Lim Yan Ran ◽

Prateek Mansingh

Keyword(s):

Public Health ◽

Oral Health ◽

Healthy Aging ◽

Dental Health ◽

The Elderly ◽

Dental Public Health ◽

Cognitive Changes ◽

Geriatric Population ◽

Health Concerns ◽

Treatment Services

Across the world, the segment of the elderly in populations is seen to be increasing at a rapid rate. There also exists a trend in which more teeth are retained as age increases due to effective dental public health measures like fluoridation. This inevitably places an increased need for dental healthcare among the geriatric populations. Since oral health greatly affects the systemic health of aged individuals, it is imperative for dentists and physicians to work together as a team to impart treatment to the best of one’s abilities for geriatric patients. It is therefore, necessary to first assess the oral health concerns surrounding the geriatric population from the perspective of public health dentistry. Relationship of the elderly with periodontal disease, dental caries, salivary hyposalivation and xerostomia, cognitive changes, and simultaneous usage of diverse medications was discussed. This paper reviewed the literature and then examined and discussed the various problems mentioned in depth and suggested recommendations for a plan of action. Knowledge about the specific oral health concerns and issues will help to better position us in developing strategies for providing better oral healthcare to the geriatric population in addition to the existing systemic healthcare. In the future, the elderly will make up a huge portion of the demographic visiting dentist regularly for a myriad of oral health problems. Dental health professionals therefore, must have adequate training and competency to deal with the predicament of this geriatric population. Preventive and treatment services can ensure healthy aging which will improve the quality of life.

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Dental public health: An introduction to community dental health

Journal of Dentistry ◽

10.1016/0300-5712(81)90010-5 ◽

1981 ◽

Vol 9 (4) ◽

pp. 348

Author(s):

A.J. Sweetman

Keyword(s):

Public Health ◽

Dental Health ◽

Dental Public Health

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Evidence-based priority setting

Australian Health Review ◽

10.1071/ah010032 ◽

2001 ◽

Vol 24 (2) ◽

pp. 32 ◽

Cited By ~ 12

Author(s):

Julie Astley ◽

Wendy Wake-Dyster

Keyword(s):

Decision Making ◽

Resource Allocation ◽

Priority Setting ◽

Evidence Based ◽

Priority Setting Process ◽

Marginal Analysis ◽

Community Values ◽

Setting Process ◽

Combine Program ◽

Program Budgeting

This paper describes evidence-based priority setting and resource allocation undertaken by a Division of the Women's & Children's Hospital, Adelaide during 1998-1999. We describe the methods used to combine program budgeting marginal analysis (PBMA), evidence based and "community values" approaches into one decision-making framework.Previous organisational changes involving the formation of multidisciplinary team and program management were pivotal in setting a framework to successfully complete the priority setting process.

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To disinvest or invest? The role of programme budgeting and marginal analysis (PBMA) for economic evaluation and prioritization between public health interventions

Applied Health Economics for Public Health Practice and Research ◽

10.1093/med/9780198737483.003.0014 ◽

2019 ◽

pp. 312-340

Author(s):

Joanna M. Charles ◽

Rhiannon T. Edwards

Keyword(s):

Public Health ◽

Resource Allocation ◽

Local Population ◽

Health Improvement ◽

Evidence Based ◽

Marginal Analysis ◽

The Impact ◽

Allocation Decisions

This chapter describes the application of programme budgeting and marginal analysis (PBMA) as an evidence-based framework to make resource allocation decisions such as whether to invest or disinvest in certain services, products, or interventions. This evidence-based eight-step decision-making process can help decision-makers to maximize the impact of healthcare resources on the health needs of a local population. Programme budgeting is an appraisal of past resource allocation in specified programmes or services with a view to tracking future resource allocation in those same programmes or services. Marginal analysis is the appraisal of the added benefits and added costs of a proposed investment or the lost benefits and lower costs of a proposed disinvestment. This chapter pays particular attention to the use of the PBMA framework to appraise a national health improvement budget as a case study to illustrate the methods practical application in public health.

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Program budgeting and marginal analysis: A guide to resource allocation

New South Wales Public Health Bulletin ◽

10.1071/nb95011 ◽

1995 ◽

Vol 6 (4) ◽

pp. 29 ◽

Cited By ~ 6

Author(s):

Rosalie Viney ◽

Marion Haas ◽

Gavin Mooney

Keyword(s):

Resource Allocation ◽

Marginal Analysis ◽

Program Budgeting

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Increasing Performance Treatment Index’s Score (PTI) of Elementary School Children in Keputih-Surabaya Through Dental Public Health Warrior Project

DENTA ◽

10.30649/denta.v11i2.101 ◽

2019 ◽

Vol 11 (2) ◽

pp. 83

Author(s):

Aulia Dwi Maharani

Keyword(s):

Public Health ◽

Elementary Schools ◽

Elementary Students ◽

Elementary School Children ◽

Dental Health ◽

Social Activity ◽

Dental Public Health ◽

T Score ◽

Before And After ◽

The Mean

Introduction:The Dental Public Health Warrior (DPHW) project is a social activity which provides a creative, fun, and interactive dental health education throughout elementary schools in Keputih Area-Surabaya,Indonesia. Purpose: The aim of this study was to determine the effectivity of those projects in increasing the Performance Treatment Index of elementary school’s student. PTI score used to measure the willingness to treat their teeth. Materials and Methods:In this pre experimental study (pretest and posttest only design), subjects were 54 elementary students (4th grade) . All subjects were educated by the DPHW team and their DMF-t score and PTI score were collected by calibrated dentists before the education and in 3 months after the education. Results: The mean of DMF-t score increase from 6,7 to 6,9. The mean of PTI score increase from 3,7 to 9,5 . Wilcoxon analysis showed there is significant different between before and after education (p= 0,001). Conclusion:. The DPHW project can be effectively used to increase the Performance Treatment Index of elementary school’s student. The increase of PTI indekx means there is increase in willingness to treat their teeth. Keywords: Dental Public Health Warrior Project, PTI score , Performance Treatment Index,elemntary school, Surabaya. Corrrespondence:Aulia Dwi Maharani, Department of Public Health, Faculty of Dentistry, Hang Tuah University,Arif Rahman Hakim 150, Surabaya,Phone 031-5945864, Email: <a href="mailto:[email protected]">[email protected]</a>.

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Setting Priorities and Allocating Resources in Regional Health Authorities: A Report from Two Pilot Exercises Using Program Budgeting and Marginal Analysis

Healthcare Management Forum ◽

10.1016/s0840-4704(10)60200-1 ◽

2002 ◽

Vol 15 (1) ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Craig Mitton ◽

Cam Donaldson ◽

Lisa Halma ◽

Nadine Gall

Keyword(s):

Priority Setting ◽

Health Sector ◽

Decision Makers ◽

Regional Health ◽

Marginal Analysis ◽

Health Authorities ◽

Program Budgeting ◽

A Priority ◽

Regional Health Authorities

A significant mandate of Canadian regional health authorities is to set priorities and allocate resources within a limited funding envelope. Program budgeting and marginal analysis is a priority-setting framework used in the health sector. This article discusses the application of the framework in two regional health authorities in Alberta. The framework was demonstrated to be effective in aiding decision makers to set priorities, and wider application of the framework in these health authorities is planned.

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