Equity in the allocation of health care resources

This paper examines some of the issues that arise when seeking to tackle health inequalities in a context of limited health care resources. Increasingly, central agencies are using devolved budgets for health care providers as a central instrument of expenditure control. Equity objectives play an important role in the resource allocation methods used to determine such budgets. Yet, unless integrated into a proper system of risk management, the use of budgets can lead to serious inequity. The paper discusses the potential contributions of different disciplines to promoting equity within a health care budgetary regime.     

调整医疗机构布局 优化卫生资源配置

以区域卫生规划思想和原则为指导，针对区卫生资源方面存在的主要问题，在政府牵头，部门配合下，通过综合配套改革，调整医疗机构布局，优化卫生资源配置，取得初步成铲。其中两点最主要的做法和体会是；解决思想，树立新的卫生发展观，正确把握资源本国垢战略导向，加强宏观调控，优化投入半量，盘活资源存量。     

Principles of allocation of health care resources.

The methods and principles of allocating centrally provided health care resources to regions and areas are reviewed using the report of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) and the consultative document (Department of Health and Social Security, 1976a) as a basis. A range of practical problems arising from these papers (especially the report of the RAWP) is described and traced to the terms of reference. It is concluded that the RAWP misinterpreted aspects of social and administrative reality, and it failed to recognise clearly that the several principles on which it had to work conflicted with each other and demanded decisions of priority. The consequential errors led to (a) an injudicious imposition of 'objectivity' at all levels of allocation, (b) an unjustified insistence that the same method be used at each administrative level in an additive and transitive manner, (c) the exclusion of general practitioner services from their considerations, (d) a failure to delineate those decisions which are in fact political decisions, thus to concatenate them, inappropriately, with technical and professional issues. The main requirement in a revised system is for a mechanism which allocates different priorities to different principles at each appropriate administrative and distributive level, and adapts the working methods of each tier to meet separately defined objectives.     

Evaluation of a methodology for financial resources allocation in Brazilian health sector

In the early 1990s, a group of British researchers developed a new methodology for healthcare resource allocation based on need. The methodology's main characteristics are to draw on the theoretical model for healthcare services demand and apply data on health services utilization to estimate needs-based use. The objective of the current study was to assess the applicability of this methodology for allocating Federal resources at the local level in Brazil. Data from all acute hospital admissions in 1999 came from the Inpatient Information System of the Unified National Health System (SUS). The country was divided into 134 geographic areas. The statistical models tested to estimate needs-based use applied the following need variables: infant mortality rate; standardized mortality rate; illiteracy rate; proportion of households headed by women; and mean number of household members. All tested models showed negative regression coefficients, indicating that the methodology is inadequate for resource allocation based on need in places like Brazil with large social inequalities in healthcare utilization.     

Mathematical programming for the efficient allocation of health care resources

Previous discussions of methods for the efficient allocation of health care resources subject to a budget constraint have relied on unnecessarily restrictive assumptions. This paper makes use of established optimization techniques to demonstrate that a general mathematical programming framework can accommodate much more complex information regarding returns to scale, partial and complete indivisibility and program interdependence. Methods are also presented for incorporating ethical constraints into the resource allocation process, including explicit identification of the cost of equity.     

Medical education and the needs of human resources in the Hungarian health care system

The strategic aims of medical education are discussing, from the view of the human resource demands in a modern healthcare system. The authors summarise the logical framework of medical functioning based on medical development and economical circumstances, and describe the role of personal skills in the daily work. Afterwards they discuss the development of medical education in the last three decades and present the tight connection between cognitive sciences and developing results mentioned above. The authors analyse some special points of the Hungarian medical faculties. In the conclusion they have shown the possibilities to support the Hungarian healthcare reform by the educational development.     

妇幼保健机构人力资源配置对服务开展的影响

目的 分析全国省、市、县三级妇幼保健机构人力资源配置现状、服务开展及医务人员工作负担情况,掌握妇幼保健机构人员配置状况对其服务开展的影响,为政府决策部门合理配置人力资源及制定卫生人力发展规划提供科学依据.方法 2014年中国疾病预防控制中心妇幼保健中心根据《各级妇幼健康服务机构业务部门设置指南》的要求设计调查问卷,在全国抽取了432所妇幼保健机构开展调查.调查妇幼保健机构孕产保健、儿童保健、妇女保健服务开展情况、未开展的原因以及人员配置.结果 省级、市级、县级妇幼保健机构在岗职工总数分别超过原核定编制数的66.3％、45.1％和28.2％.省级妇幼保健机构孕产保健、儿童保健和妇女保健未开展服务项目的比例均超过25％,其中43.6％是由于人员数量不足,13.4％是由于技术水平的限制.市级妇幼保健机构儿童保健服务未开展的比例为45.7％,其中35.2％的原因是由于人员数量不足造成的.县级妇幼保健机构孕产保健、儿童保健、妇女保健服务中未开展服务项目的比例均高于省、市两级机构,人员不足和技术水平受限分别占38.4％和29.2％.三级妇幼保健机构群体保健未开展项目的比例为11％ ～ 13％;三级妇幼保健机构每名医生日均门诊量分别为28.5人次、18.9人次和13.6人次,每医生日均负担住院床日分别为3.2、2.9、1.7床日.结论 各级妇幼保健机构均存在明显的人员编制不足、人员数量和能力不足的情况,工作负担高于综合性医院,影响了妇幼保健机构业务的开展和服务的提供,建议增加妇幼保健机构的人员配备,加强人才队伍建设,改变目前人力严重不足的现状,提高妇幼保健机构服务能力.     

新医改以来广东省卫生人力资源配置公平性及趋势预测分析

[目的]分析2009年新医改以来广东省卫生人力资源配置的现状及其公平性,并对2025年、2030年的配置情况进行预测,为广东省卫生人力资源的合理布局和优化配置提供建议.[方法]应用基尼系数测算卫生人力资源配置的公平性,并采用灰色预测模型GM(1,1)对卫生人力资源进行预测.[结果]新医改以来,广东省每千常住人口卫生技术...     

Strategic costs and preferences revelation in the allocation of resources for health care

This article examines the resources allocation process in the internal market for health care in an environment characterised by asymmetry of information. We analyse the strategic behaviour of the provider and show how, by misreporting its cost function and reservation utility, it might shift the allocation of resources away from the purchaser’s objectives. Although the fundamental importance of equity, efficiency and risk aversion considerations which have been the traditional focus of the literature on allocation of resources should not be denied, this paper shows that contracts and internal markets are not neutral instruments and more research should be devoted to studying their effects.     

西藏卫生人力资源配置与利用分析

目的:了解西藏地区卫生人力资源配置与利用中存在的不足,为完善西藏卫生人力资源配置并提高卫生人力资源利用提出政策建议。方法:利用PPS抽样方法在全区共调查各类卫生机构181家所有在岗卫生人员。结果:西藏地区级人民医院高质量人才匮乏,护士人员紧缺;各级藏医医院人员需要优化学历机构;公共卫生服务机构需要加强人员引进;县级人民医院人员职称结构和执业资质不合理。结论:需要进一步加强西藏卫生人力资源建设。     

Informal payments and intra-household allocation of resources for health care in Albania

Background  

Informal payments for health care services can impose financial hardship on households. Many studies have found that the position within the household can influence the decision on how much is spent on each household member. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children.     

Trends in geographic disparities in allocation of health care resources in the US

OBJECTIVES: This study aimed to examine current level and historical trends in health resources distribution in the US; to investigate the relationships between both levels and trends of inequality with--geographic location, inequality of income and rates per capita of hospital-beds and physicians. METHODS: The Gini Coefficient was used to measure variations in distribution of physicians and hospital-beds (at the county level) during three decades. RESULTS: Physician distribution has become less equitable, while hospital-beds' equity has increased. physicians' distribution exhibited a geographic trend, becoming more equitable in the West. No association was found between equality in hospital-beds' distribution and rates of hospital-beds per capita. CONCLUSIONS: Rates per capita might not be sufficient in determining availability of resources. Further research is needed to determine implications for health outcomes.     

我国西部地区基层卫生人力资源配置公平性研究

目的 分析2016年我国西部地区基层卫生人力资源配置情况,为进一步优化西部地区基层卫生人力资源配置提供建议。方法 综合运用卫生人力资源密度指数、基尼系数、泰尔指数对我国西部地区2016年基层卫生人力资源的公平性进行评价。结果 西部地区基层卫生技术人员、执业(助理)医师、注册护士及全科医生按人口配置的基尼系数分别是0.0628、0.0905、0.0738、0.3561,按地理配置的基尼系数分别是0.6482、0.6453、0.6515、0.6003。西部地区基层卫生技术人员、执业(助理)医师、注册护士、全科医生的泰尔指数地区内贡献率分别是47%、40%、69%、60%,地区间贡献率分别是53%、60%、31%、40%。结论 西部地区基层卫生人力资源按人口配置均优于按地理配置,地区内和地区间差异对配置公平性的影响程度不同。建议综合考虑人口和地理因素设定符合西部地域特点的卫生人力资源配置计算标准,全方位关注不同经济水平区域的基层卫生人员配置合理性等。     

浅析卫生监督人力资源的科学配备

目的 :了解目前上海市卫生监督资源配备情况,提出科学配备的重要性。方法 :以上海卫生监督管理相对人的数量着手,以完成条线覆盖率为导向,推算全市卫生监督一线执法类监督员的理论数量。同时以全市管理对象户数为底数,与年度实际监督的户次数相比较,提出科学监管的重要性。结果 :卫生监督的人力资源配备不足,监督的科学规划仍有欠缺。结论 :要合理分配卫生监督人力资源,通过科学规划和监管模式的优化等途径提高监管的有效性。