Equity In Allocation Research Articles

Police Officer Assignment and Neighborhood Crime

We develop an empirical model of the mechanism used to assign police officers to Chicago districts and examine the efficiency and equity of alternative allocations. We document that the current bidding process, which grants priority based on seniority, results in the assignment of more experienced officers to less violent and high-income neighborhoods. Our empirical model combines estimates of heterogeneous officer preferences underlying the bidding process with causal estimates of the effects of officer experience on neighborhood crime. Equalizing officer seniority across districts would reduce violent crime rate by 4.6 percent and significantly decrease inequality in crime, discretionary arrests, and officer use of force across neighborhoods. Moreover, this assignment can be achieved in a revenue-neutral way while resulting in small welfare gains for police officers, implying that it is more equitable and efficient.

Multi-scale modeling for irrigation water and cropland resources allocation considering uncertainties in water supply and demand

Irrigated agriculture is the dominant user of world’s fresh water which feeds the world’s growing population. Conflicts between stakeholders; incompatibility of economic, social, and environmental development; and uncertainties in water supply and demand restrict the sustainable development of irrigated agriculture. This study developed a multi-scale multi-objective programming model for simultaneous optimal allocation of irrigation water and cropland to balance conflicts between farmers’ income and sustainable development of irrigation districts (reflected in economic, social, and environmental aspects). Consideration of the joint uncertainties of water supply and demand helps provide practical and indicative schemes for agricultural water and land allocation. The developed model was applied to a real case study in an irrigation district in northeast China. Farmers’ income, net economic benefit, resources allocation equity, and global warming potential were coordinated by optimally allocating limited water and cropland resources to different crops in different subareas under different combinational scenarios of water supply and demand. The performance of the model was evaluated, based on the concept of “adaptability” which can help realize the degree of ability of the irrigated agricultural system to adapt to changing environment. The developed model can help plan irrigation water and cropland resources in a sustainable way, and can be a reference for similar irrigation systems worldwide.

Equity and Efficiency of Health Resource Allocation of Chinese Medicine in Mainland China: 2013-2017.

Background: In this study, we aimed to estimate the equity and efficiency of traditional Chinese medicine (TCM) health resource allocation, utilization, and trend in mainland China from 2013 to 2017.Methods: The data were downloaded from the China Health Statistical Yearbook (2014–2018) and the China Statistical Yearbook (2018). The equity of TCM health resource allocation was evaluated through the Lorenz curve, Gini coefficient (G), and Theil index (T) based on population size and geographical area. The efficiency and productivity of TCM health resource utilization were assessed using the data envelopment analysis-based Malmquist productivity index.Results: TCM health resource had an increasing trend every year. The equity allocated by population (G ranging from 0.1 to 0.3) was better than that by geographic region (G > 0.5). T in the intra-groups was higher than those in the inter-groups. The equity of TCM resource allocation was the middle region > eastern region > western region. Most provinces (29 out of 31) had negative productivity changes, suggesting deterioration in productivity. Moreover, the middle region with higher scale sizes had more redundant inputs than the other two regions. However, the low technological development (all technical values <1) might hinder productive progress.Conclusion: The equity of TCM health allocated by the population was better than that by the geographic region. The intra-regional difference was the main reason for inequity sources. Productivities in more than 97% of provinces are inefficient. The frequency distribution of scale efficiency (score > 1) had increased since 2015. However, the frequency distribution of technical change (score > 1) decreased every year. The slow technological progress and low scale size might be the main reasons for low productivity.

Equity and efficiency of health care resource allocation in Jiangsu Province, China

BackgroundJiangsu was one of the first four pilot provinces to engage in comprehensive health care reform in China, which has been on-going for the past 5 years. This study aims to evaluate the equity, efficiency and productivity of health care resource allocation in Jiangsu Province using the most recent data, analyse the causes of deficiencies, and discuss measures to solve these problems.MethodsData were extracted from the Jiangsu Health/Family Planning Statistical Yearbook (2015–2019) and Jiangsu Statistical Yearbook (2015–2019). The Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were chosen to study the fairness of health resource allocation in Jiangsu Province. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were used to analyse the efficiency and productivity of this allocation.ResultsFrom 2014 to 2018, the total amount of health resources in Jiangsu Province increased. The G of primary resource allocation by population remained below 0.15, and that by geographical area was between 0.14 and 0.28; additionally, the G of health financial resources was below 0.26, and that by geographical area was above 0.39. T was consistent with the results for G and Lorenz curves. The HRDI shows that the allocated amounts of health care resources were the highest in southern Jiangsu, except for the number of health institutions. The average value of TE was above 0.93, and the DEA results were invalid for only two cities. From 2014 to 2018, the mean TFPC in Jiangsu was less than 1, and the values exceeded 1 for only five cities.ConclusionThe equity of basic medical resources was better than that of financial resources, and the equity of geographical allocation was better than that of population allocation. The overall efficiency of health care resource allocation was high; however, the total factor productivity of the whole province has declined due to technological regression. Jiangsu Province needs to further optimize the allocation and increase the utilization efficiency of health care resources.

The New US Heart Allocation Scheme: Impact on Waitlist and Post-Transplant Survival

In October 2018, the Organ Procurement and Transplantation Network (OPTN) revised the donor heart allocation system in an attempt to prioritize those patients with highest clinical urgency, reduce waitlist morality, and improve geographic equity in organ allocation. Our goal was to review the changes in the heart allocation policy and its impact on transplant characteristics and outcomes. After the new 2018 donor heart allocation system became effective, there has been a trend toward increased use of temporary mechanical circulatory support. Also, initial reports suggested reduced post-transplant survival, although the initial analysis was limited by short follow-up and small sample size. Recent reports however illustrate survival outcomes similar to those of the previous allocation system. The new donor heart allocation policy has been associated with a change in management strategies for bridging patients to transplantation, with increased utilization of temporary mechanical circulatory support, with still uncertain effects on post-transplant survival.

Regional Disparities of Rehabilitation Resources for Persons with Disabilities in China: Data from 2014 to 2019.

Although the United Nations’ Convention on the Rights of Persons with Disabilities enshrines the right to health for all persons with disabilities (PDs), PDs face health disparities in terms of access to rehabilitation resources, which is important for service supply. This study aimed to explore the trends and distribution of rehabilitation resources for PDs in China from 2014 to 2019, explore the main factors that influence equity, and provide suggestions for policymakers. Data were obtained from the annual China Statistical Bulletin on the Development of Disabled Persons and the database of the China Disabled Persons’ Federation. Six types of rehabilitation resources were chosen to measure the trends in allocation and equity. Data on disparities were analyzed based on western, central, and eastern regions. The Health Resource Density Index and Theil Index were calculated to determine the degree and density of unfairness. The findings show a steady increasing trend in the amount of rehabilitation resources in China from 2014 to 2019. The density and equity of allocation of rehabilitation resources have improved greatly in recent years. Regional disparities were principally caused by differences within the regions. Suggestions including expanding investment in rehabilitation resources and developing rehabilitation systems were put forward.

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Abstract Background Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). The objectives of this cross-country study is to highlight to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Conclusions A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions. Key messages A minority of LTC systems in OECD countries fully meet distributional equity in allocation of resources across payer agencies. Countries that value distributional equity should harmonize the eligibility criteria to LTC at the national level and allocate funds according to needs across regions.

Decreased graft loss following implementation of the kidney allocation score (KAS)

BackgroundThe Kidney Allocation System (KAS) was developed to improve equity and utility in organ allocation. We examine the effect of this change on kidney graft distribution and survival. MethodsUNOS data was used to identify first-time adult recipients of a deceased donor kidney-alone transplant pre-KAS (Jan 2012–Dec 2014, n = 26,612) and post-KAS (Jan 2015–Dec 2017, n = 30,701), as well as grafts recovered Jan 2012–Jun 2019. ResultsPost-KAS, kidneys were more likely to experience cold ischemia time >24 h (20.0% vs. 18.8%, p < 0.001) and experienced more delayed graft function, though competing risks modeling demonstrated a lower hazard of graft loss post-KAS, HR 0.90 (95% CI 0.84–0.97, p = 0.007). Post-policy, KDPI >85% kidneys were more likely to be shared regionally (37% vs. 14%), and more likely to be discarded (60.6% vs. 54.9%) after the policy change. KDPI >85% graft and patient survival did not change. ConclusionsImplementation of the KAS has increased sharing of high-KDPI kidneys and has decreased the hazard of graft loss without an impact on patient survival.

An ecological footprint approach for cropland use sustainability based on multi-objective optimization modelling

Croplands are heterogeneous in productivity and their sustainable use holds a prominent place in supporting a virtual society-economy-ecology-environment circle. This study developed a model for the evaluation of cropland use sustainability by integrating the revised ecological footprint model with multi-objective optimization. The model enabled to gain insights into changes of the supply-demand balance of cropland use ecologically from a planning perspective, and also enables policy makers to determine the optimal patterns of cropland use in order to reconcile contradictions between multiple dimensions in agroecosystems, such as resource utilization, economy, society, and environment. The model was demonstrated by solving a real-world problem of cropland use management in Heilongjiang Province, northeast China. Results of demonstration were found to be satisfactory for generating sustainable cropland use patterns in promoting the equilibrium of water use efficiency, net economic benefit, land resource allocation equity, and greenhouse gas emissions. Then, whether various cropland use patterns were ecologically safe based on crop ecological footprint and crop ecological carrying capacity were determined. The status and scenario-based trend of cropland use sustainability provided alternatives for policy makers to allocate cropland efficiently and sustainably. The model is applicable for similar planting-centered regions with limited land and water resources.

Health equity and distributive justice considerations in critical care resource allocation

Amid the possibility of resource shortages in health care during a public health crisis, guiding principles established by several groups advocate for allocating life-sustaining treatments on the basis of a patient's chances of survival, resulting in an approach of saving the most lives possible.1 To assist in this approach, many triage frameworks use acute illness scores to predict short-term mortality.1 The sequential organ failure assessment (SOFA)2 score has received attention as a mortality prediction tool during the COVID-19 pandemic and is likely to be used by hospitals in some manner as a triage tool.

Trade-off between equity and efficiency for allocating wastewater emission permits in watersheds considering transaction

As the management of wastewater emission permits in watershed has become a growing worldwide concern, a substantial challenge has been created in balancing the social stability, economic construction, and ecological function. Therefore, the equitable and efficient allocation of wastewater emission permits in watershed integrating sustainability is vital for environmental management. Considering the wastewater discharge permits transaction between subareas, a multi-objective model is proposed to analyze the allocation of wastewater emission permits in a watershed. The first objective function is to maximize the allocation equity using the environmental Gini coefficient, and the second is to maximize the economic efficiency for the sustainable development of a watershed as the constraint. In this study, the trade-off between the equity and economic efficiency of allocation is balanced. A case study of the Tuojiang River Basin in China is conducted to demonstrate the feasibility, rationality and practicality of the model. The multi-principle and multi-objective allocation model was found to be more reliable and feasible than the previous models, indicating that the equity and efficiency should be balanced to mitigate the water scarcity and deteriorating water quality when managing the basin, and trading is an effective measure for ensuring the equity.

Triage of critical care resources in COVID-19: a stronger role for justice

Some ethicists assert that there is a consensus that maximising medical outcomes takes precedence as a principle of resource allocation in emergency triage of absolutely scarce resources. But the nature...

Governmental Options to Regulate Water Scarcity: What Can the Law Offer?

Governments all around the world have to decide on how to combat the coming water crisis. In our contribution, we analyze what the law has to offer in controlling the problem of water scarcity and fostering sustainable irrigation, the equity of water allocation, and control over environmental impacts. The main question is: “What are the governmental options to regulate water scarcity via legislation and how to become fit for the future?” Based on the theoretical framework of environmental economics, we will describe four types of possible regulation to deal with water scarcity: command and control regulation, incentive-based regulation, the supply of information, and nudges or paternalistic regulation. All these types of regulations can be used to achieve the same goal: combating water scarcity. Subsequently, based on this typology, we will review several European and non-European examples to see how supra-national and national governments are undertaking action to alleviate water scarcity, by either reducing the need for freshwater or increasing the availability of freshwater. These examples can inspire other countries around the world who are considering new forms of regulation. The examples also show that those governments are already inspiring each other; new forms of European regulation on reusing wastewater for agricultural irrigation are inspired by examples all over the world, including the Australia, the United States and India. One clear conclusion when reviewing the strategies across several countries is that the problem remains insufficiently recognized, and is therefore not as high as it should be on the political and scientific agenda. Even worse, as we will highlight, some legal frameworks have the unintended effect of creating obstacles against innovative projects which can alleviate water scarcity, and therefore the current framework of regulation functions as an impediment to preventing or solving the issue. After presenting an overview of the theory and practice, and drawing conclusions, we conclude our contribution with an overview of the questions to be considered when formulating new regulations, and three recommendations to make the regulatory framework fit for the future.

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

BackgroundA reasonable allocation of health resources is often characterized by equity and high efficiency. This study aims to evaluate the equity and efficiency of maternal and child health (MCH) resources allocation in Hunan Province, China.MethodsData related to MCH resources and services was obtained from the Hunan maternal and child health information reporting and management system. The Gini coefficient and data envelopment analysis (DEA) were employed to evaluate the equity and efficiency of MCH resources allocation, respectively.ResultsThe MCH resources allocation in terms of demographic dimension were in a preferred equity status with the Gini values all less than 0.3, and the Gini values for each MCH resources’ allocation in terms of the geographical dimension ranged from 0.1298 to 0.4256, with the highest values in the number of midwives and medical equipment (≥ CNY 10,000), which exceeds 0.4, indicating an alert of inequity. More than 40% regions in Hunan were found to be relatively inefficient with decreased return to scale in the allocation of MCH resources, indicating those inefficient regions were using more inputs than needed to obtain the current output levels.ConclusionsThe equity of MCH resources by population size is superior by geographic area and the disproportionate distribution of the number of medical equipment (≥ CNY 10,000) and midwives between different regions was the main source of inequity. Policy-makers need to consider the geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services. More than 40% of regions in Hunan were found to be inefficient, with using more health resources than needed to produce the current amount of health services. Further investigations on factors affecting the efficiency of MCH resources allocation is still needed to guide regional health plans-making and resource allocation.

Are industrial carbon emissions allocations in developing regions equitable? A case study of the northwestern provinces in China

The difficulty for developing regions to fulfil their industrial carbon emission control target commitments is to take into account the socio-economic and environmental governance. It is necessary not only to accelerate the process of industrialization, but also to rationally allocate carbon emission reduction tasks. This paper takes the northwestern provinces of China as a case study based on the calculation of the industrial carbon emissions of each province from 2006 to 2017. The Gini coefficients such as the industrial economy contribution coefficient, industrial employment contribution coefficient, and carbon carrying coefficient are constructed to evaluate the equity of regional industrial carbon emissions. The results show that the carbon pressure index in the northwestern provinces is increasing, carbon emissions are growing much faster than the carbon carrying capacity, and the differences among the provinces are obvious. The industrial economy contribution, the industrial employment contribution, and the carbon carrying Gini coefficients fluctuate significantly. Carbon emissions inequity has not been suppressed with the socio-economic development, and the “Matthew effect” is even more prominent. Evaluating the equity of carbon emissions allocation will help to rationally allocate carbon emission reduction tasks among provinces and achieve national emission reduction targets. Accordingly, recommendations are provided for formulating a differentiated carbon management policy, strengthening provincial cooperation, determining the provincial ecological function position, and improving the equity of regional carbon emissions allocation.

Efficient irrigation water allocation and its impact on agricultural sustainability and water scarcity under uncertainty

Agriculture is a key economic sector in developing countries that are facing challenges of low efficiency of water resources utilization and of shrinking water supply. This study develops an optimization model for the allocation of agricultural irrigation water to improve irrigation water use efficiency (IWUE), considering uncertainties of fluctuating water supply. Then, it assesses the impact of efficient water allocation on the sustainability and water scarcity under different levels of water supply. This study can help answer questions as to how to optimal allocate limited water supplies to different crops and different subareas under uncertainty to improve IWUE, how water shortage affects economic, social, and environmental aspects, and what the relationship between system sustainability and water shortage is. To demonstrate its feasibility, the proposed models are applied to an irrigation district in northeastern China. These models can also be applied to other regions that suffer from water scarcity. Results of application are found to be satisfactory for explaining the impact of agricultural irrigation water allocation on net economic benefit, water resources allocation equity, total greenhouse gas emissions, and water scarcity footprint under different water supply conditions. This study provides insights into tradeoffs amongst resources, economy, society, and environment in irrigated agricultural systems under uncertainty.

Efficiency and equity in regional coal de-capacity allocation in China: A multiple objective programming model based on Gini coefficient and Data Envelopment Analysis

Both governments and enterprises are giving increasing attention to creating efficient policies for coal de-capacity allocation across Chinese regions. In contrast to existing studies, we consider both efficiency and equity in the allocation of coal capacity reduction for streamlining the implementation of coal de-capacity reform. First, the coal production capacity and overcapacity in the coal production regions was estimated using the boundary production function model. Then, we constructed a multiple objective programming model based on the Gini coefficient and Data Envelopment Analysis (Gi-DEA), and applied it to coal de-capacity allocation. The main results are as follows: (1) The coal production capacity in China exceeded 5.7 billion tons by the end of 2015, and coal overcapacity is prevalent across the country. (2) The optimal allocation plan based on the Gi-DEA model achieve efficiency across the regions, and the Gini coefficient is 0.231, indicating this allocation scheme is efficient and fair. Specifically, the large coal production regions should undertake the majority of coal de-capacity, such as Shanxi, Shandong, and Guizhou, while the small and old coal production regions might undertake a heavier capacity reduction burden, such as Fujian, Guangxi, and Jiangxi. (3) The multiple objective programming model, Gi-DEA, using common weights, achieved overall efficiency of the DMUs, and generated a unique allocation plan.

Partitioning Commons and Devolving Them from Communal to Sub-Communal Groups: Evidence from China’s Community Forest Management Organizations

Existing research has extensively explored various approaches to enhancing the governance of community-managed commons; however, limited studies have discussed whether it is effective to partition commons and devolve them from communal to smaller, sub-communal groups. We examine this question based on the evidence from two common-property timber production communities that devolved their forests from the administrative village to villagers’ groups in Fujian, China. Using the comparative case study method, we explore the mechanisms by which this organizational restructuring affected democratic governance, revenue allocation and economic efficiency of timber production. We find that by decreasing the size of forest management units, the restructuring increases the participation of ordinary villagers in community forestry and enhances the equity of revenue allocation. However, physically partitioning forests may undermine scale economies, and the small, sub-communal forest management groups tend to have weak financial and managerial capacities. Thus, partitioning forests into villagers’ groups threatens the long-run efficiency of commercial timber production. This research not only presents an innovative toolkit of enhancing community forest management but also sheds light on the optimal organizational structure of community forest management under different organizational goals and contexts.

Defining a Willingness-to-transplant Threshold in an Era of Organ Scarcity: Simultaneous Liver-kidney Transplant as a Case Example.

Organ scarcity continues in solid organ transplantation, such that the availability of organs limits the number of people able to benefit from transplantation. Medical advancements in managing end-stage organ disease have led to an increasing demand for multiorgan transplant, wherein a patient with multiorgan disease receives >1 organ from the same donor. Current allocation schemes give priority to multiorgan recipients compared with single-organ transplant recipients, which raise ethical questions regarding equity and utility. We use simultaneous liver and kidney (SLK) transplant, a type of multiorgan transplant, as a case study to examine the tension between equity and utility in multiorgan allocation. We adapt the health economics willingness-to-pay threshold to a solid organ transplant setting by coining a new metric: the willingness-to-transplant (WTT) threshold. We demonstrate how the WTT threshold can be used to evaluate different SLK allocation strategies by synthesizing utility and equity perspectives. We submit that this new framework enables us to distill the question of SLK allocation down to: what is the minimum amount of benefit we require from a deceased donor kidney to allocate it for a particular indication? Addressing the above question will prove helpful to devising a rational system of SLK allocation and is applicable to other transplant settings.

Association between recipient blood type and heart transplantation outcomes in the United States

In heart transplantation (HT), although blood type O organs can go to any blood type, non-O organs may not be allocated to adult O recipients. Therefore, O candidates wait longer than non-O candidates and frequently require bridging with left ventricular assist devices (LVADs). The effects of this discrepancy are rarely investigated in a large registry. The purpose of this study was to assess the association between candidates' blood type and their outcomes after HT listing. This is a retrospective cohort study using the United Network for Organ Sharing Registry, including 34,352 candidates listed for a single-organ, primary HT from January 2000 through December 2015. Main outcome measures were waitlist mortality and post-HT mortality, using blood type A as reference. We conducted inverse-probability weighting to adjust for baseline profiles. Among 34,352 candidates (median age 55, interquartile range 46-62; female 24.8%; blood type A: 13,258, AB: 1,572, B: 4,599, O:14,923), 22,714 candidates (A: 71.5%, AB: 82.1%, B: 73.0%, O: 57.5%; p < 0.001) underwent HT during the study period. Among recipients, bridging LVAD rate was highest in O recipients (A: 23.0%, AB: 15.3%, B: 23.4%, O: 32.1%; p < 0.001). After inverse-probability weighting, O patients demonstrated a significantly higher hazard of death after listing (adjusted hazard ratio 1.11, 95% confidence interval [CI] 1.07-1.16) and after HT (adjusted hazard ratio 1.07, 95% CI 1.01-1.13) as compared with A. There is a survival discrepancy among blood types. Our findings should facilitate more prospective studies to revisit current policies regarding equity in allocation, where possible.