Inequality In Allocation Research Articles

Intra-Household Income Management and Couple’s Relative Sharing of Income and Environment Sustainability in Japan

This study aims to identify household members’ income sharing, when the amount of said income is governed by a particular household member. The results are expected to provide insightful evidence that identifies who is under the poverty line within families. This will illustrate the intra-household allocation inequality by observing the members’ household income dominance. Using the information on household income management obtained from the Japanese Household Panel Survey data (1993–2013) and the original Internet survey, this paper develops an alternative methodology to estimate the household income distribution of couples. A two-step estimation process was employed to estimate the wife’s manageable income equation. Then, the parameters were substituted into the husband’s manageable income equation to estimate the parameters for calculating the wife’s sharing rule. The results are as follows. First, a wife’s share of intra-household resources positively correlates to her manageable income resources. However, wives have weak power in expending the transferred income from their husbands. Second, the remarkable feature is that, on average, wives share 37% of the resources, meaning that the wives’ relative bargaining is weaker than the husbands’. Narrowing the gap in terms of hourly wage between husbands and wives is a crucial tool to reduce the intra-household allocation gap. Third, the wives’ relative intrahousehold income allocation improvement is associated with household environment sustainability activities. To improve the intra-household income allocation inequality, we provide an original approach to explore the intra-household head of household members’ relative income sharing. The results highlight the inequality of intra-household income distribution and confirm that reducing the income gap would be a crucial improvement factor.

Influencing factors of health resource allocation and utilisation before and after COVID-19 based on RIF-I-OLS decomposition method: a longitudinal retrospective study in Guangdong Province, China

ObjectivesTo explore factors that influenced the health resource allocation and utilisation before and after COVID-19, and subsequently offer sensible recommendations for advancing the scientific distribution of health resources.DesignA longitudinal survey...

Do Māori and Pacific Peoples Living with Dementia in New Zealand Receive Equitable Long-Term Care Compared with New Zealand Europeans?

<strong>Context:</strong> Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). <strong>Objectives: </strong>The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). <strong>Methods:</strong> Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. <strong>Findings: </strong>six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95%CI: –$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: –$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110). <strong>Conclusions:</strong> Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources.

Status Exception Use in the New Heart Allocation System: Identifying Inequalities in Allocation

<h3>Purpose</h3> The revised seven-tiered US heart allocation policy aimed to improve risk stratification to lower exception status use. However, recent literature has demonstrated that exceptions have since increased. The characteristics of patients listed as Status One and Status Two exceptions are unknown. <h3>Methods</h3> This retrospective analysis of the Scientific Registry of Transplant Candidates (SRTR) included adults listed as Status One or Two after the new heart allocation system in 2018. Multivariable logistic regression determined the association of exception status with baseline characteristics including race, heart failure etiology, comorbidities, hemodynamic parameters, and inotropic and mechanical support. <h3>Results</h3> 9,418 patients have been listed for heart transplant since the new policy implementation. 728 were designated as Status One with 217 (29.8%) utilizing an Exception; 3,686 as Status Two with 1425 (38.7%) utilizing an Exception. In comparison to White patients, African-American race was associated with Status Two exception use (OR 1.28, 95%CI 1.08-1.52, p<0.05). In comparison to patients with an ischemic etiology, congenital heart disease (CHD) (OR 3.46, 95%CI 2.21-5.54, p<0.05), infiltrative cardiomyopathy (CMP) (OR 2.08, 1.40-3.10, p<0.05), and restrictive CMP (OR 3.27, 95%CI 1.63-6.83, p<0.05) were all associated with Status Two exception use, as were higher cardiac output (OR 1.09, 95%CI 1.03-1.15, p<0.05) and lower pulmonary capillary wedge pressure (OR 0.97, 95%CI 0.97-0.98). Patients with familial CMP (2.00, 95%CI 1.43-2.78, p<0.05) and infiltrative CMP (5.52, 95%CI 3.75-8.11, p<0.05) were more likely to be African-American. <h3>Conclusion</h3> Status exceptions in the new policy can lead to inequalities in organ allocation. CHD and infiltrative CMP may not meet hemodynamic criteria for transplant listing, leading to increased exception use. Patients with familial and infiltrative CMP were more likely to be African-American, which may lead to inequalities in the new system.

Structural Features of China's Industrial Pollution Inequality: A Spatial-Temporal Distribution Perspective

With growing concerns about the allocation inequality of environmental benefits and pollution, it is crucial to investigate whether a special characteristic of China’s environmental inequality has emerged. The present study aims to elucidate the regional spatial features of industrial pollution inequality (IPI) (waste gas, wastewater, and solid waste measured by the Theil index separately) and their relevance to national territorial space planning strategies. Furthermore, we make a novel attempt to develop an integrated framework that employs a developed-Kaya identity with the Logarithmic Mean Divisia Index method to uncover the driving force of IPI disparities. We make use of the data published recently by the provincial panel of China, during the period 2000–2015. Based on this information, we found notable spatial-temporal heterogeneity in China’s IPI, highly correlated to China’s core national territorial space planning strategy, the “T-shaped” spatial development strategy. The empirical results support the “structural features” hypothesis in IPI for China. In particular, the Coastal Region has a great edge in industrial pollution equality. In most provinces in the Inland Corridor along the Yangtze River, the trend of IPI has been alleviated to some extent. However, provinces further inland that are off-side the two axes of “T-shaped” spatial development strategy have to respond to the two-fold challenge of the exacerbated trend in IPI both within and between the regions. Our findings also indicate that the effect of technological inequality is the main driving force for IPI in the earlier stage of development. However, effects of economic inequality together with that of economic structure inequality manifest in the middle or transition period and the economic inequality effect is the determinant in the later stage of development. Additionally, contributions of size effect and inequality effect are changeable over development process, economic inequality effect outweighs the economic size effect for IPI in more developed districts or districts in higher developing phases. These findings may help the government incorporate environmental equality goals into regional policies and contribute to the emerging literature on environmental inequality.

A distributed robust optimization model based on water-food-energy nexus for irrigated agricultural sustainable development

Sustainable agricultural development covers all aspects of agricultural production involving the water-food-energy nexus (WFEN) and considers the effects of agricultural activities on society, economy and ecology. Multi-objective optimization models play an important role in making tradeoff among multiple interests of stakeholders.Aimed at canal-based irrigated agricultural areas, water allocation highly depends on canal distribution, and the spatial location of irrigation regions determines their water-intake order, which usually induces serious water allocation inequality. The social, economic and ecological problems resulting from water inequality would deteriorate without intervention and seriously impact sustainable development. Thus, optimization models must consider water use equity, water-intake order as well as water equilibrium simultaneously. However, this will greatly increase computational efforts and solution difficulty. The problem becomes worse when uncertain factors are involved.In order to overcome these difficulties, a distributed multi-objective uncertain optimization model was established to help develop comprehensive strategies for agricultural sustainability. A novel robust solution method was proposed to offer an efficient way to handle stochastic and fuzzy uncertainties from the perspective of feasibility and optimality robustness. Finally, a case study was conducted to demonstrate the practical application of the developed model. The results offer managers insights on agricultural sustainable development.

Gini index based initial coin offering mechanism

As a fundraising method, Initial Coin Offering (ICO) has raised billions of dollars for thousands of startups. Existing ICO mechanisms place more emphasis on the short-term benefits of maximal fundraising while ignoring the problem of unbalanced token allocation, which negatively impacts subsequent fundraising and has bad effects on introducing new investors and resources. We propose a new ICO mechanism which uses the concept of Gini index for the very first time as a mechanism design constraint to control allocation inequality. Our mechanism has an elegant and straightforward structure, which makes it explainable. It allows the agents to modify their bids as a price discovery process, while limiting the bids of whales. Under natural technical assumptions, we show that under our mechanism most agents have simple dominant strategies and the equilibrium revenue approaches the optimal revenue asymptotically in the number of agents. We verify our mechanism using real ICO dataset we collected, and confirm that our mechanism performs well in terms of both allocation fairness and revenue.

Accessibility Assessment of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation.

Equity in accessible healthcare is crucial for measuring health equity in community care policy. The most important objective of such a policy in Taiwan is empowering people and communities by improving health literacy and increasing access to healthcare resources. Using the nearest-neighbor two-step floating catchment area method, this study performed an accessibility assessment for community care resources before and after supply capacity optimization. For the target of maximum equity when allocating community care resources, taking maximum values, mean values and minimum values of the distances into consideration, three analytical allocation solutions for supply capability optimization were derived to further compare disparities in geographical accessibility. Three indicators, namely, the Gini coefficient, median minus mean and mean-squared error, were employed to assess the degree of optimization of geographical accessibility scores at the locations of the demand population and to determine the degree of geographic inequities in the allocation of community care resources. Our study proposed a method in which the minimum value of the distance is adopted as the approximate representation of distances between the service point and the locations of demand to determine the minimum value for supply capacity optimization. The study found that the method can effectively assess inequities in care resource allocation among urban and rural communities.

Regional inequalities and the role of federal resources in the SUS: do political factors affect the allocation of funds?

The research problem in this paper is a discussion of the political factors affecting the allocation of federal resources in the SUS (Unified Health System) and its effects on regional inequalities in Brazil. The main objective was to explore the influence of political factors as criteria for the distribution of federal funds, considering the regional inequalities of the country. A mixed method was used by collecting quantitative data to study the allocation of resources for each unit of the Federation, from 2003 to 2017, in search of outliers, which require more in-depth explanation based on qualitative research methods. The fuzzy-set QCA software was applied in the qualitative research phase for identification of technical and political conditions, where required and/or sufficient, for an atypical distribution of resources from one year to another. The quantitative analysis demonstrated the decrease of regional inequalities in allocation of resources to States in the North and Northeast. However, when studying the constraints of the distribution of the funds for the States of these regions, qualitative analysis demonstrated the influence of political factors on the allocation of resources, rather than purely technical factors.

Allocation inequality in cost sharing problem

This paper considers the problem of cost sharing, in which a coalition of agents, each endowed with an input, shares the output cost incurred from the total inputs of the coalition. Two allocations—average cost pricing and the Shapley value—are arguably the two most widely studied solution concepts to this problem. It is well known in the literature that the two allocations can be respectively characterized by different sets of axioms and they share many properties that are deemed reasonable. We seek to bridge the two allocations from a different angle–allocation inequality. We use the partial order: Lorenz order (or majorization) to characterize allocation inequality and we derive simple conditions under which one allocation Lorenz dominates (or is majorized by) the other. Examples are given to show that the two allocations are not always comparable by Lorenz order. Our proof, built on solving minimization problems of certain Schur-convex or Schur-concave objective functions over input vectors, may be of independent interest.

Continuous distribution as an organ allocation framework.

The Scientific Registry of Transplant Recipients (SRTR) supports the Organ Procurement and Transplantation Network (OPTN) efforts to better align liver allocation with the Final Rule. Here, we review recent literature related to removing place of residence or listing from organ allocation policy and describe how SRTR may help advance the OPTN policy development process. In December 2018, the OPTN Board of Directors endorsed the recommendation from OPTN's ad hoc Committee on Geography to develop organ-allocation policies that do not rely on geographic boundaries, called 'continuous distribution.' Many objections to wider organ distribution stem from efforts to address inequities in allocation for populations within geographic regions rather than for individual patients. A continuous distribution system could equitably address the needs of individual patients, merging ethical-medical urgency with geographic feasibility. The effort to remove geographic boundaries from organ distribution and allocation has been controversial. An integrated continuous distribution system may help focus the debate on priorities that matter most to patients.

Lorenz comparison between Increasing serial and Shapley value cost-sharing rules

In this paper, we consider the cost (surplus) sharing problem when a coalition of agents operates under a common production technology and share the total cost (resp. output), given their individual demands (resp. input). We compare the allocation inequality between the Moulin–Shenker’s (Increasing) serial and Shapley shares in the Lorenz sense, and show that Increasing serial share dominates the Shapley value when the marginal is decreasing, while the opposite is true when the marginal is increasing. Together with earlier comparisons between the two and the average shares, and the comparison between Increasing and Decreasing serial rules, the result implies a complete Lorenz ordering in equality among the four common sharing allocations: Average, Increasing serial, Decreasing serial and the Shapley value.

OR43 Racial inequity among 0-ABDR mismatched kidney recipients

Aim The implementation of the new Kidney Allocation Schema (KAS) in Dec. 2014 brought about important changes to deceased donor (DD) kidney allocation. Most notable has been for Highly Sensitized candidates who receive national, regional and local priority based on CPRA. However, the second ranked allocation category, 0-ABDR mismatch (MM), has actually experienced a drop in transplant rates from ∼8.2% pre-KAS to ∼4.7%, 1 yr post-KAS(AJT 16:1834; 2016). As both equity and utility are part of UNOS mission, we sought to assess the racial makeup of 0-ABDR MM recipients and donors. Methods A data request was made via the OPTN web site (optn.transplant.hrsa.gov/data/request-data/) and the returned data-set contained 1,517 0-ABDR mismatched kidney recipients transplanted between 12/04/2014 and 6/30/2017. Demographics collected included: CPRA, Race, Gender and HLA type. Analysis focused on the racial distribution of recipients by the following CPRA groups: 100%, ⩾50 0 Results Among 0-ABDR MM recipients, 47% were females while 60% of the donors were male. The overall racial distribution of DDs for 0-MM recipients was: White: 78.4%, Black: 4.2%, Hispanic: 14.2%, Am Indian-Alaska Native: 0.7%, Hawaiian-Pacific Islander: 0.06% and Multiracial: 0.7% which differs from all DDs. The racial distribution of 0-MM recipients, by CPRA group, is shown in Fig. 1. Conclusions Across all CPRA groups, African Americas (AA) and Asians receive disproportionally fewer 0-ABDR mismatch allografts than Whites or Hispanics when compared to their proportion of the wait list. Among the 100% CPRA group AAs receive more transplants than Hispanics likely due to KAS national allocation policy. However, in all other CPRA groups, Whites and Hispanics receive more allografts than any other group likely due to the racial composition of DDs. Given that the frequency of 0-ABDR MM transplants has dropped significantly since KAS, and the clear racial inequity in allocation, it may be time to reassess the priority/utility of this category. Download : Download high-res image (259KB) Download : Download full-size image

Allocation Inequality in Cost Sharing Problem

This paper considers the problem of cost sharing, in which a coalition of agents, each endowed with an input, shares the output cost incurred from the total inputs of the coalition. Two allocations---average cost pricing and the Shapley value---are arguably the two most widely studied solution concepts to this problem. It is well known in the literature that the two allocations can be respectively characterized by different sets of axioms and they share many properties that are deemed reasonable. We seek to bridge the two allocations from a different angle---allocation inequality. We use the partial order: Lorenz order (or majorization) to characterize allocation inequality and we derive simple conditions under which one allocation Lorenz dominates (or is majorized by) the other. Examples are given to show that the two allocations are not always comparable by Lorenz order. Our proof, built on solving minimization problems of certain Schur-convex or Schur-concave objective functions over input vectors, may be of independent interest.

Indonesia’s Village Fiscal Transfers: A Fiscal Decentralisation Review

This study intends to discuss the empirical aftermath of Indonesia’s first policy implementation of the Village Law 2014 the village fiscal transfers: the new village fund (Dana Desa) from the state with the prior fiscal transfers from the regency for the villages, focussing on allocation and expenditure action in Banjar Regency, South Kalimantan Province. The study findings show that the village fiscal transfers are dominantly allocated equally/same amount for every village and some allocated proportionally depend on the weight of village variables. Despite resulting inequality in allocation, the main considerations of the alloca- tion method are to have village fiscal sufficiency and maintain state-regency- villages relation. The high increase of expenditures is mostly in infrastructure development and remuneration for village officials. In spending, the village gov- ernment has to improve the accountability especially the punctuality of upward accountability and starts to initiate the downward accountability. Overlapping authorities between regency and village, and limitations in human resources should be solved immediately to smooth the process of decentralisation to vil- lages.

Inequities in the allocation of medical resources in China’s Township Health Centers

Purpose The purpose of this paper is to produce a high-quality measure of the nature of healthcare resources available in China’s Township Health Centers (THCs), paying particular attention to equity between high- and low-income areas. Design/methodology/approach This study makes use of data from a nearly nationally representative survey in rural China conducted by the Center for Chinese Agricultural Policy at the Chinese Academy of Sciences in 2011. The samples of towns were selected randomly from 25 counties located in five provinces from different regions of China. Data were collected through questionnaires and direct observation. Findings The THCs located in rich areas have higher levels of human resources than poor areas. THCs in rich areas also have more fixed assets than those in poor areas. In fact, even though the Chinese Ministry of Health mandates that all THCs have certain basic levels of medical equipment and facilities, many THCs in poor areas do not have them. The allocation of mandated equipment is unequal. Practical implications These findings suggest that China’s government should pay more attention to THCs located in poor areas, especially in light of new initiatives to improve health care in poor rural areas. Originality/value This is the first nationally representative study to employ rigorous empirics to investigate the extent of inequality in allocation of resources within THCs across China.

Student Veterans and Service Members in Higher Education by Jan Arminio, Tomoko Kudo Grabosky, &amp; Josh Lang (review)

Reviewed by: Student Veterans and Service Members in Higher Education by Jan Arminio, Tomoko Kudo Grabosky, & Josh Lang Susan V. Iverson Student Veterans and Service Members in Higher Education Jan Arminio, Tomoko Kudo Grabosky, & Josh Lang New York, NY: Routledge, 2015, 168 pages, $34.77 (softcover) Arminio, Grabosky, and Lang provide compelling coverage of a segment of students on US institutions of higher education: student veterans and military service members (SVSM). The coverage in the volume is reflective of the multiple perspectives of the author team, as researcher, practitioner, and student veteran. Reflective of these three perspectives, the volume includes empirical evidence, stemming from their multi-site case study of cultural conflict experienced by SVSM during their transition to the military and then to higher education; it illuminates best practices and calls for practitioner advocacy for SVSM students as they navigate campus barriers; and this volume draws heavily on SVSM voices (from their data) to narrate the cultural conflicts during transition experiences. Following an introductory preface, the authors provide a rich and well-researched overview of “the long but inconsistent tradition of veterans’ benefits” (p. 1). This comprehensive historical context stirs the reader to consider “how and when those benefits included education” (p. 1), but the authors also use their overview of historical shifts and evolutions to foreshadow issues later discussed in the volume. For instance, the authors illuminate (historical) institutionalized inequities in allocation or distribution of benefits, and the reader can see these vestiges in a later chapter on (in)equity issues. It is not hard to connect the historical reality that “prior to World War II, women who serviced in the nurse corps were not providing any rank or benefits” (p. 7), with “strong stereotypes in society that women are not ‘real veterans’ or that they are not exposed to ‘real danger’ compared to male veterans” (p. 119). The authors’ description of Bonus Marchers—a group of veterans in the 1930s who marched from Oregon to Washington, DC in protest of poor economic conditions (i.e. few benefits and high unemployment)—foreshadows organizing by SVSM on campus, but also their discussion of the need for practitioners to possess advocacy competencies. I appreciated the authors’ strategic use of history to foreshadow what followed in the volume. In chapter 2, the authors describe the methodology for their multi-site case study, and analyze and discuss their findings through a cultural lens. The authors contrast military [End Page 756] culture, characterized by collectivism, rigid hierarchical structures, and masculinity (p. 27), with higher education (and civilian) culture, characterized by “individualistic values, personal responsibility, independent thinking, and democratic principles” (p. 29). Interestingly, the authors draw upon theoretical work that has typically “focused on students from different countries or ethnic and racial backgrounds” (p. 29). This intriguing application of works, such as Hofstede’s cultural dimensions and Berry’s model of acculturation, invites the reader to think more broadly about what it means to be culturally competent. Calls for student affairs professionals to be (multi) culturally competent (a point the authors discuss further at the beginning of chapter 4) demand that individuals “be aware of their own assumptions, biases, and stereotypes” (p. 42), including, the authors emphasize, those held about military culture. The authors’ description of an advocacy model (in chapter 4) is an important contribution of this book. With acknowledgment that the field of student affairs has emphasized the importance of developing professional competencies, and specifically multicultural competence, they also note the need for advocacy competency as “an essential social justice strategy” (p. 58). They observe the “lack of literature on advocacy” in student affairs and the “need to go beyond the field of higher education to search for literature that offers advocacy strategies” necessary for higher education administrators (p. 59). They turn to the ACA Advocacy Competencies (citing Lewis, Arnold, House, & Toporek, 2002), adapting the ACA model to illuminate how student affairs professionals can advocate for SVSM students at an individual level (see Table 4.1 on p. 61), an institutional level (see Table 4.2 on p. 65), and for engaging in socio-political advocacy at a systemic level (see Table 4.3 on p. 70). While the authors’ focus is...

Analysis of the Emerging China Green Era and Its Influence on Small and Medium-Sized Enterprises Development: Review and Perspectives

Small and Medium-sized Enterprises (SMEs) play a vital role in China’s economy as generators of employment, revenue and innovation. With the unprecedented economic development of China, the increase of small and medium-sized enterprises (SMEs) number has resulted in a massive resources and energy consumption that produces significant generation of waste by-products. The purpose of this study is to demonstrate that China is facing an emerging green era. The raise of Chinese environmentalism is strongly correlated with the economic development of middle class, which involves not only environmental activists, but also social stakeholders and the media. Responding to the country’s pollution and the increasing public pressure, the government has started to enforce its environmental laws with the 12th Five-Year Program. New environmental regulations and standards are issued every day, and the number of environmental inspection is increasing to insure firms’ compliance. The study also reveals that government legislation and financial support are mandatory to support improvement of SMEs environmental performances. Similarly, stakeholders have started to play an increasing role in firms’ adoption of greener strategies and practices into their management systems. Customers demand for green products, non-governmental organizations campaigns and pollution scandal revealed by the media are starting to pressure SMEs to be greener. However, Chinese SMEs are still facing numerous challenges that limit their efforts in implementing environmental management system: difficulties to comply with the changing government legislation, inequity in allocation of government subsidies, lack of managers engagement to reduce firms environmental impact, lack of technological absorptive capacity, lack of financial resources, lack of knowledge regarding environmental management and channel to connect with universities or others institutions.

Geographically Equitable Liver Allocation Using Mathematical Redistricting

Introduction: Geographic equity has proven elusive in the United States liver allocation system. Proposals for broader sharing between donor service areas (DSAs), which are grouped into regions, have not been approved. The regional groupings were not designed for equitable organ sharing. Methods: Mathematical optimization methods have been used to organize voting districts or school districts; here we apply them to design organ sharing regions within the United States. Inputs are donation and waiting list registration rates, as well as distances between DSAs. The resulting regional maps are tested using the Liver Simuated Allocation Model to find median MELD at transplant within each region and DSA, among other metrics. Results: Two alternative regional maps are proposed. Either of these alternative maps would reduce geographic disparities. The variance of median MELD at transplant among the DSAs is significantly lower using either of the alternative maps (by Levene's robust test statistic, p < 0.05). Note that although broader sharing within the existing regions would reduce predicted waitlist deaths from 1658.3 to 1600.8, it would actually worsen geographic disparity as demonstrated by a larger standard deviation of median MELD among DSAs.Figure: [Alternative Map 1]Figure: [Liver simulated allocation model results]Conclusion: Simply offering organs over a broader geographic area will not necessarily reduce geographic inequity in organ allocation. Summary metrics, like the number of people who die on the waiting list, could possibly improve at the same time that disparity metrics like the range of organ availability in different places worsens; allocation changes intended to address disparities must be evaluated using direct disparity metrics that measure variation. Mathematical redistricting may help reduce geographic inequity in allocation.

The role of proximity to death in need-based approaches to health care

ObjectivesThis study examines the role of proximity to death (PTD) in need-based approaches to health care by: (1) investigating whether PTD is a statistically significant, independent predictor of health-care use; and (2) estimating PTD's marginal impact on need-based allocation of health-care resources. MethodsThe primary data source is the Canadian National Population Health Survey (NPHS), a longitudinal survey that uses vital statistics to confirm deaths of the respondents. We use two-part models separately for general practitioner, specialist, and short stay inpatient hospital services. We calculate per-capita allocation, with and without PTD, from the Canadian federal government to its ten provinces and by income groups. ResultsPTD is a robust and important predictor of health-care resource use for each service even after adjustment for other need and non-need factors. PTD's marginal impact on allocation is relatively small in the contexts we examined, but failure to include PTD could introduce inequity in allocation by disadvantaging populations with greater need. ConclusionsPTD is an important need indicator when modeling health-care resource requirements. It deserves greater attention in need-based approaches to health-care planning and resource allocation.