Equity In Allocation Research Articles

FRI-437 - Validation of a Method for Establishing Allocation Equity among Patients with and without Hepatocellular Carcinoma on a Common Waiting List

FRI-437 - Validation of a Method for Establishing Allocation Equity among Patients with and without Hepatocellular Carcinoma on a Common Waiting List

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China.

BackgroundThis study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China.MethodsWe analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators.ResultsThe CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the “best practice frontier”. The other 8 (25.8%) provinces were technically inefficient.ConclusionsHealth professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.

An emergency dispatch model considering the urgency of the requirement for reliefs in different disaster areas

Abstract: Purpose: Frequent sudden-onset disasters which have threatened the survival of human and the development of society force the public to pay an increasing attention to emergency management. A challenging task in the process of emergency management is emergency dispatch of reliefs. An emergency dispatch model considering the urgency of the requirement for reliefs in different disaster areas is proposed in this paper to dispatch reliefs reasonably and reduce the effect of sudden-onset disasters. D esign/methodology/approach: Firstly, quantitative assessment on the urgency of the requirement for reliefs in different disaster areas is done by an evaluation method based on Fuzzy Comprehensive Evaluation and improved Evidence Reasoning which is proposed in this paper. And then based the quantitative results, an emergency dispatch model aiming to minimize the response time, the distribution cost and the unsatisfied rate of the requirement for reliefs is proposed, which reflects the requests of disaster areas under emergency, including the urgency of requirement, the economy of distribution and the equity of allocation. Finally, the Genetic Algorithm is improved based on the adaptive crossover and mutation probability function to solve the emergency dispatch model. Findings and Originality/value: A case that the Y hydraulic power enterprise carries on emergency dispatch of reliefs under continuous sudden-onset heavy rain is given to illustrate the availability of the emergency dispatch model proposed in this paper. The results show that the emergency dispatch model meets the distribution priority requirement of disaster area with the higher urgency, so that reliefs are supplied more timely. Research limitations/implications: The emergency dispatch model faced to large scale sudden-onset disasters is complex. The quantity of reliefs that disaster area requires and the running time of vehicles are viewed as available information, and the problem that how to obtain the information is not considered. Practical implications: The emergency dispatch model considering the urgency of the requirement for reliefs in different disaster areas is applicable to a realistic emergency dispatch of reliefs under sudden-onset disasters and the research results is the foundation of further research on the problem of emergency management. Originality/value: This paper proposes emergency dispatch model considering the urgency of the requirement for reliefs in different disaster areas which can meet the realistic requirement that the disaster area with the higher urgency has an priority to obtain the reliefs and make reliefs be distributed timely.

Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014).

BackgroundGAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time. This paper charts that evolution.MethodsA systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI’s phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries.ResultsSerches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI’s predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes.ConclusionIn its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2521-8) contains supplementary material, which is available to authorized users.

Public-private-partnership in healthcare delivery in China: policy and feasible models

This study introduced the concept of healthcare delivery PPP, and analyzed its policies.Based on such policy analysis, the authors discussed its practical model from such aspects as cooperation content, cooperation width and depth, in consideration of the special properties of healthcare delivery.The government is proposed to deepen the health reform on a whole while encouraging PPP model in healthcare delivery in view of its impacts on the equity and efficiency of health resources allocation. Key words: Public-private-partnership; Healthcare delivery; Policy analysis; Feasibility

Assessing equity and sustainability of water allocation in Colombia

ABSTRACTBased on the national database of 28,104 water rights (concessions) granted in Colombia, this paper presents an analysis of how the principles of equity and sustainability are reflected in water allocation. Concessions appear to be an exclusionary mechanism since only a minority of small water users have concessions and the distribution of water volumes among those who have them is extremely inequitable. The 2009 Gini coefficient calculated for water concessions granted for agriculture was 0.90 compared with the rural land Gini of 0.88 (both indicators grouping holdings under the same entity). More than half of the Colombian departments have a higher Gini coefficient for water than for land, suggesting that water rights are at least as unequally distributed as land, in one of the most inequitable countries in Latin America. Water allocated to domestic, agriculture and hydropower use indicates a lack of consistency of water allocation criteria across regions. The volumetric and administrative attributes of water allocation in Colombia do not account for environmental flows or the concerns of marginalised groups of society that have limited access to the mechanism. Water allocation as a technical task, with limited transparency and secluded from public scrutiny, does not contribute to the solution of increasing water-related conflicts.

Empirical research of the impacts of the essential medicine system based on the double-difference model upon the first contact orientation of the residents

Objective To analyze the policy effect of first contact care options of residents under the essential medicine system. Methods The samples were divided into a treatment group and a control group depending whether the policy is implemented.Difference-in-differences model was used to estimate the changes in the First Contact Care choice of residents before and after the implementation. Results The net effect of policy is 6.15%, in which the resident category of the household head and per capita income were statistically significant. Conclusion Though the system promotes the first contact of residents for primary institutions, top-level design of the system calls for optimization, efficiency and equity of the health resource allocation of urban and rural health need to be improved, and the division of responsibilities of the two-level medical institutions needs to be clarified in first contact care system. Key words: Difference-in-differences model; Essential medicine; Primary medical institutions; First contact care option; Health resources distribution

Developing markets for water reallocation: Revisiting the experience of Spanish water mercantilización

Economic instruments are being promoted as a desirable alternative to public sector action in the allocation and management of natural resources. A wide body of literature has developed that critically analyzes this phenomenon as part of a wider project of ‘neoliberalization of nature’, trying to uncover the underlying rationale and commonalities of geographically specific phenomena. The case of water is at the vanguard of these processes and is proving to be particularly contentious. In the European Union water policies are increasingly emphasizing the application of economic instruments to improve the allocative equity and economic efficiency in the use of scarce resources. However, there are few analyses of how these instruments are really working on the ground and whether they are meeting their objectives. This paper aims to contribute to this debate by critically analyzing the experience with water markets in Spain, the only country in the European Union where they are operative. It looks at water permit sales during the 2005–2008 drought period using the Tajo–Segura transfer infrastructure. The paper describes how the institutional process of mercantilización of water works in practice in Spain. It shows that the use of markets requires an intense process of institutional development to facilitate and encourage their operation. These institutions tend to favor the interests of clearly identifiable elites, instead of the public interest they supposedly promote.

Optimal funding allocation strategies for safety improvements on urban intersections

Urban intersections crashes cause significant economic loss. The safety management process undertaken by most states in the United States is referred to as Highway Safety Improvement Program and consists of three standardized steps: (i) identification of critical crash locations, (ii) development of countermeasures, and (iii) resource allocation among identified crash locations. Often these three steps are undertaken independently, with limited detail of each step at the state planning agencies. The literature review underlines the importance of the third step, and the lack of sophisticated tools available to state planning agencies for leveraging information obtained from the first two steps. Further, non-strategic approaches and unavailability of methods for evaluating policies may lead to sub-optimal funding allocation. This paper overcomes these limitations and proposes multiple optimal resource allocation strategies for improvements at urban intersections that maximize safety benefits, under budget and policy constraints. Proposed policy measures based on benefits maximization (economic competitiveness), equitable allocation (equity), and relaxation of mutually exclusiveness (multiple alternatives at one location) produce significantly different alternative and fund allocation. The proposed models are applied to selected intersections in four counties of southeast Michigan. Results reinforce the applicability of the strategies/policies and tools developed in this paper for safety project funding allocation on critical urban intersections.

Have health human resources become more equal between rural and urban areas after the new reform?

The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.

Satisfaction with fishing and the desire to leave.

Predicting who may leave a fishery is an important consideration when designing capacity reduction programs to enhance both ecological and economic sustainability. In this paper, the relationship between satisfaction and the desire to exit a fishery is examined for the Queensland East Coast Trawl fishery. Income from fishing, and changes in income over the last 5years, were key factors affecting overall satisfaction. Relative income per se was not a significant factor, counter to most satisfaction studies. Continuing a family tradition of fishing and, for one group, pride in being a fisher was found to be significant. Satisfaction with fishing overall and the challenge of fishing were found to be the primary drivers of the desire to stay or leave the fishery. Surprisingly, public perceptions of fishing, trust in management and perceptions of equity in resource allocation did not significantly affect overall satisfaction or the desire to exit the fishery.

Utilization of Community-based Health Information Systems in Decision Making and Health Action in Nyalenda, Kisumu County, Kenya

Information should form the backbone of decisions that effect change in all areas. It is therefore paramount in health, for information to be used for decision making. In effect this will bring about equity in health resource allocation. The development of comprehensive community based health information systems is increasingly becoming important for measuring and improving the quality of health services. Many developing countries including Kenya have made efforts to strengthen their national health information systems to provide information for decision-making in managing health care services. The purpose of this paper is to explore how data collected at the community level is utilised by various stakeholders within the community in order to produce actionable information for decision making. This was a descriptive, cross sectional study. The qualitative aspects of data collection involved key informant interviews and focused group discussions with the health service providers; potential health services users, and community health workers. Findings indicated that strong local ownership of data developed at the community. The main perspectives of service providers included joint ownership of health intervention programs at the community level, the community owned their health and aimed to improve it and community health workers to champion on health and development issues to bring about change.

The ethical problem of randomization.

The Fondazione Umberto Veronesi ethics committee recently published a statement concerning the inherent ethical issues of randomized clinical trials (RCTs), mainly focusing on randomization, raising many questions, and suggesting possible solutions. The main concern is that the patients enrolled in a RCT are used to improve medical knowledge, but they cannot be the beneficiaries of the results of the trials in which they are participating. Possible solutions come from a wider use of clinical and administrative databases, and an early termination of trials. We discuss this statement, emphasizing that the scientific and ethical reason for embarking on a clinical trial is uncertainty. The uncertainty regarding the comparative benefits and harms of each compared treatment (clinical equipoise) warrants equity in allocation. Randomization allows one to obtain unbiased evidence that we cannot know in advance. The expected probability of a new treatment to be successful describes the limits within which a study can be acceptable both from an ethical as well as a scientific point of view. Most people accept enrollment in a RCT if the probability of success of the experimental treatment is between 50 and 70%. The assumption and concern that there is a conflict between "scientific" and "ethical" aspects of a clinical trial due to randomization should at least be mitigated, considering that only scientifically sounded studies can be considered ethical. Randomization remains the appropriate approach to ensure the study's internal validity. Different aspects seem to be more important, from the ethical point of view, considering RCT and their publication.

Methods for measuring horizontal equity in health resource allocation: a comparative study.

ᅟThere are many existing methodologies on measuring health equity, while seldom has method aiming at health resource allocation. We collected 6 method of measuring equity in health resource allocation. This paper presents key contents of methods on measuring horizontal equity in health service allocation, yet each method has its advantages and disadvantages as well as range of application, which may help researchers or government to make wise decision when choosing appropriate method for measuring equity. Through comparative analysis, we concluded that socioeconomic factors were considered in concentration index; although the Lorenz curve and Gini-coefficient are widely used, which exist uncertainty and incompleteness; overall inequality can be decomposed by Theil index, which is of significance for the planning of urban and rural areas; preferences on a certain class can be set artificially by Atkinson index; it is easy for Chi-square to analyze aided with statistical software; specific regional differences can be calculated by index of dissimilarity.Classification codesI1Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0010-x) contains supplementary material, which is available to authorized users.

Waiting time predicts survival after liver transplantation for hepatocellular carcinoma: a cohort study using the United Network for Organ Sharing registry.

Recipients of liver transplantation (LT) for hepatocellular carcinoma (HCC) have an 8% to 20% risk of HCC recurrence. Single-center studies suggest that a period of waiting after HCC therapy may facilitate the selection of patients at low risk for post-LT HCC recurrence and mortality. We evaluated whether a longer waiting time after Model for End-Stage Liver Disease (MELD) prioritization for HCC predicts longer post-LT survival. From the United Network for Organ Sharing registry, we selected 2 groups registered for LT between March 2005 and March 2009: (1) HCC patients receiving MELD prioritization and (2) non-HCC patients. Patients were stratified by their MELD status at LT (a marker of time on the wait list after HCC MELD prioritization) and were followed from LT until death or censoring through October 2012. By comparing post-LT survival to intention-to-treat (ITT) survival from registration, we assessed predictors of post-LT survival and estimated the benefit of LT. The median MELD scores at LT were 22 (HCC) and 24 (non-HCC). A higher MELD score at LT was independently associated with lower post-LT mortality in the HCC group [hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.73-0.98] and higher post-LT mortality in the non-HCC group (HR = 1.20, 95% CI = 1.15-1.25). Compared with the HCC group, the non-HCC group had lower post-LT mortality [relative risk (RR) = 0.85, log-rank P < 0.01] but higher ITT mortality (RR = 1.25, log-rank P < 0.01) because of a 33 percentage point lower probability of undergoing LT. In conclusion, a longer waiting time before LT for HCC predicted longer post-LT survival in a national transplant registry. Delaying LT for HCC may reduce disparities in ITT survival and access to LT among different indications and thereby improve system utility and organ allocation equity for the overall pool of LT candidates.

Integrated water resources management and water users' associations in the arid region of northwest China: A case study of farmers' perceptions

Water scarcity is a critical policy issue in the arid regions of northwest China. The local government has widely adopted integrated water resources management (IWRM), but lacks support from farmers and farm communities. We undertook a case study in the Minqin oasis of northwest China to examine farmers' responses to IWRM and understand why farmer water users' associations (WUAs) are not functioning effectively at the community level. Results of quantitative and qualitative surveys of 392 farmers in 27 administrative villages showed that over 70% of farmers disapprove of the IWRM market-based reforms. In particular, the failure of farmer WUAs can be attributed to overlapping organizational structures between the WUAs and the villagers' committees; mismatches between the organizational scale of the WUAs and practical irrigation management by the farmers themselves; marginalization of rural women in water decision-making processes; and the inflexibility of IWRM implementation. An important policy implication from this study is that rebuilding farmer WUAs is key to overcoming the difficulties of IWRM. The current water governance structure, which is dominated by administrative systems, must be thoroughly reviewed to break the vicious cycle of tension and distrust between farmers and the government.

The Extent and Predictors of Waiting Time Geographic Disparity in Kidney Transplantation in the United States

Waiting time to deceased donor kidney transplant varies greatly across the United States. This variation violates the final rule, a federal mandate, which demands geographic equity in organ allocation for transplantation. Retrospective analysis of the United States Renal Data System and United Network for Organ Sharing database from 2000 to 2009. Median waiting time was calculated for each of the 58 donor service areas (DSA) in the United States. Multivariate regression was performed to identify DSA predictors for long waiting times to kidney transplantation. The median waiting time varied between the 58 DSAs from 0.61 to 4.57 years, ranging from 0.59 to 5.17 years for standard criteria donor kidneys and 0.41 to 4.69 years for expanded criteria donor kidneys. The disparity in waiting time between the DSAs grew from 3.26 years (range, 0.41-3.67) in 2000 to 4.72 years (range, 0.50-5.22) in 2009. In DSAs with longer waiting times, there were significantly more patients suffering from end-stage renal disease and more patients listed for kidney transplant, lower kidney procurement rates, and higher transplant center competition. Patients were more likely black, sensitized, with lower educational attainment and less likely to waitlist outside of their DSA of residence. Donor organs used in DSAs with long waiting times were more likely hepatitis C positive and had a higher kidney donor profile index. Graft and patient survival at 5 years was worse for deceased donor kidney transplant, but rates for living donor kidney transplant were higher. Our analysis demonstrates significant and worsening geographic disparity in waiting time for kidney transplant across the DSAs. Increase in living donor kidney transplant and use of marginal organs has not mitigated the disparity. Changes to the kidney allocation system might be required to resolve this extensive geographic disparity in kidney allocation.

Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review.

This review aims to identify, assess and analyse the evidence on equity in the distribution of public health sector expenditure in low- and middle-income countries. Four bibliographic databases and five websites were searched to identify quantitative studies examining equity in the distribution of public health funding in individual countries or groups of countries. Two different types of studies were identified: benefit incidence analysis (BIA) and resource allocation comparison (RAC) studies. Quality appraisal and data synthesis were tailored to each study type to reflect differences in the methods used and in the information provided. We identified 39 studies focusing on African, Asian and Latin American countries. Of these, 31 were BIA studies that described the distribution, typically across socio-economic status, of individual monetary benefit derived from service utilization. The remaining eight were RAC studies that compared the actual expenditure across geographic areas to an ideal need-based distribution. Overall, the quality of the evidence from both types of study was relatively weak. Looking across studies, the evidence confirms that resource allocation formulae can enhance equity in resource allocation across geographic areas and that the poor benefits proportionally more from primary health care than from hospital expenditure. The lack of information on the distribution of benefit from utilization in RAC studies and on the countries' approaches to resource allocation in BIA studies prevents further policy analysis. Additional research that relates the type of resource allocation mechanism to service provision and to the benefit distribution is required for a better understanding of equity-enhancing resource allocation policies.

Inclusiveness in the value base for health care resource allocation

This paper provides an overview of Mooney's contributions to the use of community values in priority setting and resource allocation in health care. It focuses on his ‘communitarian claims’ perspective and highlights how moral arguments for community involvement can be translated into specific processes needed to implement this approach in practice. Different examples of where Mooney sought to define and measure the constituents of claims and their relative importance in relation to equity in resource allocation are discussed. The paper also highlights challenges around the weighing up of claims and the elicitation of community preferences, many of which were acknowledged and debated by Mooney himself.

HLA-DQ Barrier

Panel-reactive antibody (PRA) testing provides assessment of the breadth of sensitization a patient might have against human leukocyte antigen (HLA) antigens. The evolution of calculated PRA (cPRA) reflects the commitment of the transplant community to increase accessibility and promote equity to all patients awaiting kidney transplantation. Recent data from our center and others, however, suggested that a significant diversity of HLA-DQ antigens is not captured, which may lead to inequity in allocating cPRA points. HLA-DRB1-DQA1-DQB1 typing of 2182 individuals was evaluated for this study using Luminex-based sequence-specific oligonucleotide typing. A total of 3182 haplotypes were confirmed to have the level of resolution required for this study. The diversity of HLA-DQαβ alleles is greater than what is apparent using the serologic equivalents. The distribution of these alleles within a serologic group varies, with some alleles being more frequent than others; therefore, their representation within the current cPRA system is inaccurate. Three informative examples are given. Haplotypes of DR antigens with DQαβ alleles did not always follow the common published linkage disequilibrium, especially in populations where there is greater genetic diversity. The current cPRA system does not take into account the distribution of molecular equivalents within DQ serologic specificities. This can result is inequitable allocation of sensitization points and disadvantaging the more sensitized patients. To ameliorate this situation, the United Network for Organ Sharing system should allow inputting HLA-DQαβ alleles both for donor typing and as antibody specificities, which will lead to better representation of unacceptable DQ alleles and improve organ allocation equity.