scholarly journals Talking liberties: John Rawls's theory of justice and psychiatric practice

2006 ◽  
Vol 12 (3) ◽  
pp. 202-210 ◽  
Author(s):  
George Ikkos ◽  
Jed Boardman ◽  
Tony Zigmond
Keyword(s):  
Decision Making ◽  
Political Philosophy ◽  
Resource Allocation ◽  
John Rawls ◽  
Theory Of Justice ◽  
Law And Ethics ◽  
Political Philosopher ◽  
Scarcity Of Resources ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Scarcity of resources compared with need results in resource-allocation decisions that will have a beneficent effect on some clinical populations and will be detrimental to others. Political philosophy, through theories of social justice, aims to establish generally applicable principles to guide such decision-making. We introduce here the work of the foremost liberal political philosopher of the second half of the 20th century, John Rawls. As well as having implications for resource allocation, John Rawls's work is of relevance to law and ethics in clinical practice, especially for psychiatrists, who often work with vulnerable, disadvantaged and stigmatised people.

La Idea de “Razón Publica” (y su Revisión) en el Último Rawls

2003 ◽  
Vol 11 (22) ◽  
pp. 5-31
Author(s):  
Fernando Aranda Fraga ◽  
Keyword(s):  
Political Philosophy ◽  
Public Good ◽  
John Rawls ◽  
Public Reason ◽  
Political Liberalism ◽  
The Political ◽  
Theory Of Justice ◽  
Key Topics ◽  
Political Philosopher

In 1993 John Rawls published his main and longest work since 1971, where he had published his reknowned A Theory of Justice, book that made him famous as the greatest political philosopher of the century. We are referring to Political Liberalism, a summary of his writings of the 80’s and the first half of the 90’s, where he attempts to answer the critics of his intellectual partners, communitarian philosophers. One of the key topics in this book is the issue of “public reason”, whose object is nothing else than public good, and on which the principles and proceedings of justice are to be applied. The book was so important for the political philosophy of the time that in 1997 Rawls had to go through the 1993 edition, becoming this new one the last relevant writing published before the death of the Harvard philosopher in November 2002.

Resource allocation and economic evaluation in Australia's healthcare system

2011 ◽  
Vol 35 (3) ◽  
pp. 278 ◽  
Author(s):  
Abdolvahab Baghbanian ◽  
Ian Hughes ◽  
Freidoon A. Khavarpour
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Healthcare Decision ◽  
Effectiveness Analysis ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use. Design. Web-based survey. Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey. Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future. Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change. What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions. What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places. What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.

CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

2013 ◽  
Vol 29 (2) ◽  
pp. 174-184 ◽  
Author(s):  
Julie Polisena ◽  
Tammy Clifford ◽  
Adam G. Elshaug ◽  
Craig Mitton ◽  
Erin Russell ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Resource Allocation ◽  
Case Studies ◽  
Resource Allocation Decision ◽  
Cochrane Library ◽  
Fee For Service ◽  
Allocation Decision ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective:Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care.Methods:An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED.Results:Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted.Conclusions:Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

scholarly journals Randomized distributed access to mutually exclusive resources

2005 ◽  
Vol 2005 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Moshe Dror ◽  
Bruce Hartman ◽  
Gary Knotts ◽  
Daniel Zeng
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Access To Resources ◽  
Computational Overhead ◽  
Multiagent Resource Allocation ◽  
Decentralized Decision Making ◽  
Resource Requirements ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Many systems consist of a set of agents which must acquire exclusive access to resources from a shared pool. Coordination of agents in such systems is often implemented in the form of a centralized mechanism. The intervention of this type of mechanism, however, typically introduces significant computational overhead and reduces the amount of concurrent activity. Alternatives to centralized mechanisms exist, but they generally suffer from the need for extensive interagent communication. In this paper, we develop a randomized approach to make multiagent resource-allocation decisions with the objective of maximizing expected concurrency measured by the number of the active agents. This approach does not assume a centralized mechanism and has no need for interagent communication. Compared to existing autonomous-decentralized-decision-making (ADDM)-based approaches for resource-allocation, our work emphasizes achieving the highest degree of agent autonomy and is able to handle more general resource requirements.

EVALUATION CRITERIA OF PATIENT AND PUBLIC INVOLVEMENT IN RESOURCE ALLOCATION DECISIONS: A LITERATURE REVIEW AND QUALITATIVE STUDY

2017 ◽  
Vol 33 (2) ◽  
pp. 270-278 ◽  
Author(s):  
Zahava R.S. Rosenberg-Yunger ◽  
Ahmed M. Bayoumi
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Literature Review ◽  
Public Involvement ◽  
Stakeholder Involvement ◽  
Evaluation Criteria ◽  
Patient And Public Involvement ◽  
Noticeable Effect ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objectives: We developed specific evaluation criteria to assess patient and public involvement in resource allocation decisions in health care.Methods: We reviewed the literature from health and other sectors relevant to stakeholder involvement and conducted twenty-seven key informant interviews with stakeholders knowledgeable about patient and public involvement in Canadian drug resource allocation decisions. We used an inductive qualitative thematic approach to analyze the interviews with codes and categories developed directly from individuals’ interview transcripts.Results: Integrating respondents’ comments and the literature review, we identified nine evaluation criteria of patient and the public involvement in healthcare resource allocation decision making: clarity regarding rationale and roles of patient and public members, sufficient support, adequate representation of relevant views, fair decision-making processes, legitimacy of committee processes, adequate opportunity for participation, meaningful degree of participation, noticeable effect on decisions, and considerations of the efficiency of patient and public involvement.Conclusions: Our results will help to develop methods to evaluate patient and public involvement in healthcare decision making.

scholarly journals Translating evidence into practice: a longitudinal qualitative exploration of allied health decision-making

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer White ◽  
◽  
Kellie Grant ◽  
Mitchell Sarkies ◽  
Terrence Haines
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Allied Health ◽  
Health Resource ◽  
Health Resource Allocation ◽  
Randomized Controlled ◽  
Group 2 ◽  
Allocation Decisions ◽  
Resource Allocation Decisions ◽  
Health Managers

Abstract Background Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. Methods A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved. Results Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints? Conclusions This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.

Commentary on the article “Key principles for the improved conduct of health technology assessments for resource allocation decisions”

2008 ◽  
Vol 24 (03) ◽  
pp. 365-366 ◽  
Author(s):  
David Hailey
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Health Technology ◽  
Decision Making Process ◽  
Broad Scope ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

The paper presents a set of principles that cover the broad scope of HTA from formulation of the question to effects on the decision-making process. It also provides goals for HTA programs to aim for in producing assessments. The principles are supported by material that includes illustrations from the experience of several programs. The authors have had long contact with the field and are well able to authoritatively discuss a range of methodological and other topics. The paper includes a range of views and details that are relevant to those involved with HTA.

The Relational Nature of Case Manager Resource Allocation Decision Making: An Illustrated Case

2010 ◽  
Vol 11 (3) ◽  
pp. 151-156 ◽  
Author(s):  
Kimberly D. Fraser ◽  
Carole Estabrooks ◽  
Marion Allen ◽  
Vicki Strang
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Home Care ◽  
Case Manager ◽  
Care Program ◽  
Resource Allocation Decision ◽  
Allocation Decision ◽  
Daily Work ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed, observed, and shadowed 11 case managers within a children’s home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna’s story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna’s story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics.

A Common Approach to Risk Analysis for Homeland Security Decision-Making

2003 ◽  
Author(s):  
J. Robert Sims ◽  
Bilal M. Ayyub ◽  
Kenneth R. Balkey ◽  
Richard E. Feigel
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Risk Analysis ◽  
Homeland Security ◽  
Broad Spectrum ◽  
Allocation Of Resources ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

For many years, risk analysis has been used extensively to inform decisions by government and industry. Different methodologies have been employed, resulting in differences in terminology and approach that make it difficult to compare the results of analyses in different fields. Dealing with terrorist threats requires prioritizing the allocation of resources across a broad spectrum of possible targets. Therefore, a common approach is needed to allow comparison of risks. This paper provides a brief outline of an approach that will allow the results of risk analyses performed using current methodologies to be expressed in a common format and terminology to facilitate resource allocation decisions. The results of a risk analysis should never be the only basis for decision-making, but a decision made without employing risk analysis will probably not result in the best outcome.

scholarly journals Translating evidence into practice: A longitudinal qualitative exploration of allied health decision making.

2020 ◽  
Author(s):  
Jennifer White ◽  
Kellie Grant ◽  
Mitchell Sarkies ◽  
Terrence Haines
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Focus Groups ◽  
Allied Health ◽  
Policy Recommendation ◽  
Health Resource ◽  
Health Resource Allocation ◽  
Allocation Decisions ◽  
Resource Allocation Decisions ◽  
Health Managers

Abstract BackgroundHealth policy and management decisions rarely reflect research evidence. In response, it is important to determine how to improve evidence-informed decision-making. As part of a broader study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. MethodsAllied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and sub-acute rehabilitation wards were eligible for inclusion. Consenting participants were randomised to: (1) control group or; (2) Implementation Group 1: received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) Implementation Group 2: received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. Serial focus groups were conducted with a sample of over 80 allied health managers recruited to Implementation Group 2 only. Out of 6 waves of recruitment, up to four focus groups were conducted with each wave during the 12 months study period. In total 17 health services participated in serial focus groups according to their allocated wave, over a 12-month study period. Data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved.ResultsResults provide insights into resource allocation and decision-making, including the interplay between barriers and facilitators concerning implementation of recommendations outlined in evidence-based policy recommendation document. Five key themes emerged: (1) Local data trumps, or is more influential; (2) How good is the evidence and does it apply to us; (3) It is difficult to change things; (4) Historically that’s how we have done things; and (5) What if we get complaints?ConclusionsThis study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence base practice from fully, and successfully occurring such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes.

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