Principles Of Resource Allocation Research Articles

Allocation of Rehabilitation Services: Who Gets a Home Evaluation

The purpose of this study was to (a) identify and describe the subpopulation of rehabilitation inpatients who receive specialized occupational therapy home evaluation services, and (b) examine these data for evidence of inequalities in access to services based on patient gender, race, age, and health insurance status. An archival review was conducted of all inpatient admissions (7,871) to a large urban rehabilitation hospital between January 1, 1994, and December 31, 1998. We had complete data on 7,791 of these patients of whom 6,038 were eligible to receive a home evaluation. Patient demographic data and Functional Independence Measure (FIM) data were obtained in electronic form from the hospital information system. Analysis showed that 12.4% (749/6038) of eligible inpatients received an in-home evaluation, and those who did were significantly more dependent (as measured by the FIM) than those who did not (p < 0.0001). We found no evidence of inequalities in access to this specialized rehabilitation service on the basis of gender, race, age, and type of medical insurance after controlling for level of functional independence. This study found no evidence of inequalities in the allocation of home evaluation services. However, it raises the larger question of how we determine whether inequalities exist. A proper assessment of inequalities in service provision requires that we know the principles by which these services should be allocated and have appropriate measures of the application of these principles. For programmatic and policy reasons, more research is needed to develop well-defined principles of resource allocation, and adequate measures of their impact so we can know whether resources and services are distributed in the way we intend.

Principles for priority setting in mental health services and their implications for the least well off.

Funding for mental health services has declined in recent years, posing the difficult challenge of setting program and individual client service priorities with reduced resources. The author reviews seven principles for resource allocation and their potential impact on people with severe and persistent mental illness. These principles address issues of the autonomy of individual health care needs; the need for client, stakeholder, and provider input into goal setting; cost-effectiveness; equity and fairness; client responsibility for making effective use of services; the impact of private industry on the development and marketing of new treatments; and the importance of considering local skill availability and population needs in setting program priorities. Because none of these principles take precedence over the others, their joint application does not necessarily yield consistent program priorities. However, they provide a frame of reference for approaching the task of priority setting and for understanding why priorities may vary from different perspectives.

Rethinking the Allocation of Teaching Resources: Some Lessons From High-Performing Schools

Although a great deal of debate surrounds the level and allocation of resources to public schools, very little research addresses how schools might organize teaching resources more effectively at the school level. This article describes case studies of five high-performing public schools that have organized professional resources in innovative ways. The study sought to detail alternative ways of deploying instructional resources in order to provide concrete alternatives to traditional organization of teachers and to quantify objectively the ways in which these schools use resources differently depending on their instructional goals and strategies. Although the schools studied looked very different from one another, they shared six principles of resource allocation that are outlined in this article. The article develops a framework for examining the use of resources and a methodology that may be used to measure the extent to which schools use their resources in focused ways to support teaching and learning.

Rethinking the Allocation of Teaching Resources: Some Lessons from High-Performing Schools

Although a great deal of debate surrounds the level and allocation of resources to public schools, very little research addresses how schools might organize teaching resources more effectively at the school level. This article describes case studies of five high-performing public schools that have organized professional resources in innovative ways. The study sought to detail alternative ways of deploying instructional resources in order to provide concrete alternatives to traditional organization of teachers and to quantify objectively the ways in which these schools use resources differently depending on their instructional goals and strategies. Although the schools studied looked very different from one another, they shared six principles of resource allocation that are outlined in this article. The article develops a framework for examining the use of resources and a methodology that may be used to measure the extent to which schools use their resources in focused ways to support teaching and learning.

Economics, Ethics and Environmental Problems

The relevance and usefulness of mainstream or neoclassical economics has been questioned more in some fields of inquiry than in others. Against the background of an attempt to characterize environmental problems, the fruitfulness of conventional ideas of economic analysis, as carried out in practice in the form of cost-benefit analysis, is questioned. Alternative approaches judged to be more compatible with environmental problems are indicated. It is argued that cost-benefit analysis represents a closed ethic or ideology and that approaches which open the way for various possible ethical or ideological standpoints are more promising. Different principles of resource allocation or housekeeping should be considered and the idea of only one “scientifically correct” or “true” principle abandoned. Non-monetary principles of housekeeping, such as specific versions of ecological ethics, are not “less economic” than the now dominant monetary principles.

Statistical lives and the principle of maximum benefit.

In recent years there has developed a growing recog nition that publicly financed health services need to utilise explicit principles of resource allocation.1 Policy makers have come to recognise this need in the light of evidence which suggests that increases in the supply of health services will be matched by an increase in the demand that is made upon them. Thus increasing expenditure on medical resources does not of itself solve the persistent problem of scarcity; resources will always be insufficient for the demands upon them. Combine this fact of scarcity with the acknowledgement that there are relatively efficient and inefficient ways of providing and delivering health services, and the need for explicit principles of allocation becomes plain. Yet the recognition of the need for principles does not of itself help us to develop such principles. The question still remains: on what basis should one allocate the limited resources that are available to health services in order to bring about an ethically acceptable allocation ? A particular example of this dilemma is provided by the problem of striking the correct balance between preventive and curative medicine. Thus, it has recently become fashionable to assert that available resources might be used to best effect if they were devoted more extensively to preventive measures with the implication that they might be switched from the curative services.2 But the notion of best effect is left undefined in this context. What is meant by the assertion that preventive services are likely to be more efficient than curative services ? Efficiency in this context only has meaning in relation to a specified set of objectives. So in order to judge the claim that one use of resources is more efficient than another, we need to formulate a set of objectives in terms of which we can measure the performance, or output, of different types of services, or inputs. In order to formulate these objectives it is neces sary that the community have a method for placing a value on the lives of its members. The manner in which the decision on allocating health services is made is then best pictured as follows.3 The com munity decides, by means of the political process, how much money is to be devoted to health services in total. This decision represents, in effect, the community's evaluation of health services by com parison with other desirable goods, like transport facilities, education, defence and housing. Having made this decision, which in practice is usually little more than an incremental decision from previous years' expenditures, the public authorities must decide how best to use available resources. In the short term they may not have much room for manoeuvre. Personnel will have been trained, capital goods reacquired and revenue thereby com mitted. But in the longer term the public authorities should be seeking to move towards the most efficient use of resources possible, otherwise effort will be wasted and things left undone which ought to be done. What criterion should the public authorities use in making this decision on allocation ? A seductively attractive, if ambiguous, proposal in this context is that, in their health expenditures, the public authorities should seek to maximise the value of lives saved or prolonged. This decision-making process in practice begs the question of what value the community assigns to the lives of its members. What typically emerges from the process is the goal simply of maximising the number of lives saved or the average length of life for members of a given population. Thus the widespread use of population mortality rates or standardised mortality ratios in the appraisal of health service performance provides a measure of effectiveness only on the assumption that what is of interest is simply the number of lives saved or the numbers multiplied by the increases in average length of life.4 No differential value is attached to the lives of different persons. Each is counted for one and no one for more than one. The criterion has in fact a certain ethical attractiveness to it. Because lives are weighted equally there will be no deliberate bias or discrimination involved in the selection or treatment of beneficiaries from the health services. Moreover, provided the technical problems can be solved in estimating the effectiveness of various forms of service, that is provided what economists

Life-history evolution in Anodonta piscinalis (Mollusca, Pelecypoda) : Correlation of parameters.

The correlations between certain life-history parameters (reproductive effort, reproductive life-span, age of first reproduction, general growth index, variation in juvenile survival, availability of resources) were studied in 13 populations of the mussel Anodonta piscinalis in south-western Finland in 1975 and 1976Reproductive life-span correlated positively (r s=0,823, P<0.001) with variation in juvenile survival. The average availability of resources correlated negatively both with the reproductive life-span (r s=-0.841, P<0.001 after the variation by juvenile survival had been deleted) and variation in juvenile survival (r s=-0.676, P<0.05).The reproductive effort for female mussels at each site was computed by comparing body weight of reproductive females with body weights of non-reproductive individuals. Availability of resources was much higher in 1976 than in 1975. Consequently, the reproductive effort, an index of the strain of reproduction, was higher in 1975 than in 1976. In 1975 there was a significant correlation between reproductive effort and the length of the reproductive life-span (-0.727, -0.806) and also with the reproductive effort and the variation in juvenile survival (-0.718, -0.758) in females of the length of 60 mm and 70 mm respectively. In 1976, when availability of resources was better, such correlations were not found.Spatial and temporal change in the intake of resources complicates applicability of the principle of resource allocation in the theory of life-history evolution. Studying the mere allocation is not enough if the intake of resources varies in the groups studied. The ratio ovary weight/body weight is a dubious measure of reproductive effort in comparative studies when the input of resources can vary, and this possibility can be ruled out only exceptionally.Correlation between growth and reproductive effort was positive, obviously because both are important components in creating high reproductive capacity. In 1975 reproductive effort increased with size (age). Change in reproductive effort correlated with reproductive life-span (r s=-0.633, P<0.05).The following parameters occurred together: short reproductive life-span, low age of first reproduction, high reproductive effort, rapid growth and high clutch size. They were realized at sites where the availability of resources was good and variation in juvenile survival was low-i.e. the environment was stable. The results conflict with the prediction of the theory of r and K-selection.

"A New Economic Order": Etienne Clementel and French Economic Diplomacy during the First World War

ranging that the country would inevitably face a severe and complex problem of reconstruction. What kind of solution did the French government have in mind? Traditional historiography had a simple answer: the government hoped that German reparations would solve the whole problem. But, in fact, during the war the French government had worked out an economic policy in which reparation played a very subordinate role. Instead, the government basically pinned its hopes on Allied cooperation-or, more precisely, on the continuation into the reconstruction period of the inter-Allied economic system that had gradually taken shape during the war. These plans for the regularization of the international economy were closely linked to plans for economic organization at home. In both cases the aim was to suppress the free market: coordination through state channels would replace competition as the fundamental principle of resource allocation.

A Re-Appraisal of the Principles of Resource Allocation

A rejection of the theories of welfare economics carries with it the judgment that there is at present no rule or method by which we may judge of the relative efficiency of alternative forms of economic organization; indeed, that any conceivable set of production plans or any conceivable set of prices, no matter how arbitrary, are-in our present state of knowledgeto be considered as good as any others. Few economists, even among those who are wont to treat welfare economics with extreme scepticism, will go as far as this to avoid courting the subject while economists of the liberal school who talk of a presumption in favour of the market mechanisms must, if they are to rationalize this presumption, invoke some theory of welfare. Put at its bluntest then it is in pursuit of an answer to the question, by what lights are we to distinguish between a good allocation and a chaotic one, that we are led willy-nilly into the domain of welfare economics. Notwithstanding the logic of this conclusion a great deal continues to be written concerning economic efficiency which deliberately eschews the language of welfare economics, relying instead on apparently more acceptable criteria-for instance, the ' common sense' rule that total receipts should be able to cover total costs supplemented, perhaps, by rules about marginal equalities. For the abiding impression seems to be that by confining oneself to the traditional rules governing the allocation of resources one somehow circumvents the tenuous concepts and fine paradoxes of welfare economics. After all, there are critiques and counter-critiques of welfare economics and in the process a great deal of smoke and subtlety is generated. But the principles of resource allocation are of more solid stuff. They are ever with us and in continual application. This view, however, does not bear close examination. A by-product of this paper will be the demonstration that certain familiar welfare criteria and the so-called optimum conditions of resource allocation are raised on the same foundation: they stand or fall together. In fact the relationship is so close it is almost inevitable that allocative criteria