Changing patterns of resource allocation in a London teaching district.

The health plans of the Tower Hamlets district management team were studied to determine what effects the report of the Resource Allocation Working Party and the White Paper "Priorities in the Health and Social Services" have had on resource allocation in a teaching district. The study showed that at present acute services are allocated a greater proportion of the district budget than occurs nationally, while geriatrics, mental health, and community services receive proportionately less. In the next three years spending on acute services is expected to decrease, while spending on geriatric facilities and community services will increase. Nevertheless, cuts in acute services will take place mainly through a reduction in the number of beds serving a community function, concentrating all acute services in the teaching hospital. Services to the district might be better maintained by creating a community hospital to meet the needs of patients who would otherwise need to be accommodated in acute beds with unnecessarily expensive support services.     

Drug reimbursement: indicators of inappropriate resource allocation

AIMS: In many countries, governments and third parties find themselves paying for (reimbursing) unproven, inadequate products limiting their ability to invest in therapies with evidence of relevant patient benefit. We examined how three characteristics, level of therapeutic evidence, susceptibility of inappropriate prescribing, and intercountry variation can be used to identify inefficiencies in pharmaceutical reimbursement among four European Union countries, Austria, Belgium, the Netherlands and Sweden. METHODS: Specific classes of medicines were chosen to provide useful examples of how healthcare resources could be reallocated. A high level of therapeutic evidence was defined as a substantial body of evidence in at least one indication with clear-cut support of relevant patient benefit. The susceptibility of inappropriate prescribing was defined as the likelihood of prescribing a drug outside the scenario for which clear-cut evidence (if any) has been documented to produce relevant benefit for the patient. The intercountry variation represents the variation in utilization of reimbursed drugs across the four countries. RESULTS: The combination of these characteristics provides a useful tool for assessing appropriate reimbursement decisions. It would be beneficial to healthcare payers as well as patients to move resources from products that have a low level of therapeutic evidence and a high susceptibility of inappropriate prescribing to products with a high level of therapeutic evidence and low susceptibility of inappropriate prescribing, and to use intercountry variation as a signal of drug classes that should be subject to further scrutiny. CONCLUSIONS: A method is presented to help policy-makers identify inefficiencies in the spending of limited health care resources, and to reallocate resources to products that have been shown to improve patient care through evidence-based medicine.     

A review of alternative approaches to healthcare resource allocation

The resources available for healthcare are limited compared with demand, if not need, and all healthcare systems, regardless of their financing and organisation, employ mechanisms to ration or prioritise finite healthcare resources. This paper reviews alternative approaches that can be used to allocate healthcare resources. It discusses the problems encountered when allocating healthcare resources according to free market principles. It then proceeds to discuss the advantages and disadvantages of alternative resource allocation approaches that can be applied to public health systems. These include: (i) approaches based on the concept of meeting the needs of the population to maximising its capacity to benefit from interventions; (ii) economic approaches that identify the most efficient allocation of resources with the view of maximising health benefits or other measures of social welfare; (iii) approaches that seek to ration healthcare by age; and (iv) approaches that resolve resource allocation disputes through debate and bargaining. At present, there appears to be no consensus about the relative importance of the potentially conflicting principles that can be used to guide resource allocation decisions. It is concluded that whatever shape tomorrow's health service takes, the requirement to make equitable and efficient use of finite healthcare resources will remain.     

The role of public opinion in drug resource allocation decisions

Drug resource allocation decisions have a very real and direct impact on the public, due to cost and availability constraints resulting from these decisions. This presents an opportunity for public opinion to play an important role in influencing decisions that have far-reaching effects. Public opinion regarding pharmaceutical issues is influenced by drug companies, special interest groups, researchers and others. Since these groups often have conflicting goals, they may send contradictory messages to the public. In this article, we examine the issues of who comprises the public, how public opinion is influenced and what impact public opinion does and should have on drug resource allocation decisions. We emphasise that, for appropriate resource allocation decisions to be made, there is a continuing need to conduct high quality outcomes research and to continue the trend of increasing interest in how drugs are used rather than how much is sold or how much they cost. There is also a major role for pharmacoeconomic research to play in this issue, with a real need to make such research accessible and understandable by the public, including patients, physicians, pharmacists and policy makers, so that policy decisions can be based on such research.     

Alcoholism: Illness beliefs and resource allocation preferences of the public

BACKGROUND: Alcohol-dependent patients are at risk of being denied necessary care because of their diagnosis. We sought to find out whether public illness beliefs influence resource allocation decisions of the public, thus putting alcohol-dependent patients at a disadvantage compared to those suffering from other medical and mental disorders. METHOD: A telephone survey involving the adult German population was conducted in 2004 (n = 1012). Participants were asked to name three out of nine conditions for which they would prefer resources not to be cut should general cutbacks within the health care budget be necessary. For all conditions we asked about personal attitudes and illness beliefs. RESULTS: Schizophrenia and alcoholism were chosen least frequently when it was a question of being spared from budget reductions. Compared to other diseases, alcoholism was considered to be particularly self-inflicted and evoked a high desire for social distance. The perceived severity of the disease, the perceived own risk of becoming alcohol dependent, and the notion that alcoholics are themselves responsible for their illness were associated with resource allocation decisions. CONCLUSION: Alcohol-dependent patients are at risk of being structurally discriminated within the health care system.     

新冠肺炎疫情期间医院人力资源调配策略

2020年2月,世界卫生组织(WHO)宣布新型冠状病毒肺炎(COVID-19)成为国际关注的突发公共卫生事件.中国应对新型冠状病毒肺炎疫情工作已经到了关键时期,如何做好疫情期间人力资源调度工作,特别是医疗、护理人员医院内部、外部人力资源调配平衡问题是战胜此次疫情重要因素之一.本研究针对在疫情期间医院人力资源调配问题进行浅析,为疫情防控期间各医院人力资源调配提供参考.     

Screening for psychiatric morbidity in men and women.

This paper describes the use of the general health questionnaire (GHQ) to screen a random sample of men for psychiatric morbidity. The results are contrasted with those from the earlier Otago Women's Health Survey, an investigation into the sociodemographic determinants of psychiatric morbidity in Otago women. The level of psychiatric morbidity found in the men was equal to that found in the women which is in contrast to most overseas studies where men have been found to have lower levels of psychiatric morbidity to women. Significant differences were found in male and female demographic subgroups. High GHQ scores were found in separated, widowed and divorced men, men in higher socioeconomic status groups and those unemployed. High GHQ scores were found among the women aged 18-34, women who had never married, those in lower socioeconomic status groups and those unemployed. This study illustrates that gender needs to be considered alongside traditional sociodemographic factors when studying psychiatric morbidity and symptomatology.     

重症监护护理评分系统在ICU护理人力资源配置中的应用研究

目的探讨重症监护护理评分系统用于ICU护理人力资源配置中的效果。方法选取我院ICU收治的80例患者作为研究对象,按照随机数字表法将其分为实验组和对照组,各40例,对照组采规医护人员平均分配模式,实验组采取重症监护护理评分系统模式。比较两组医疗费用、住院时间、并发症发生率、护理满意度与护理质量。结果实验组住院时间、医疗费用、并发症例数、满意程度与医护人员满意情况优于对照组,差异有统计学意义(P 0.05);两组护理质量评分比较差异明显,有统计学意义(P 0.05)。结论在ICU护理人力资源配置过程中,采取重症监护护理评分系统的模式有利于确保人力资源的合理配置,提高护理的效果。     

Hospitalization costs and resource allocation in cholecystectomy with use of intravenous versus oral acetaminophen

Objective: To evaluate intravenous (IV) acetaminophen (APAP) vs oral APAP use as adjunctive analgesics in cholecystectomy patients by comparing associated hospital length of stay (LOS), hospital costs, opioid use, and rates of nausea/vomiting, respiratory depression, and bowel obstruction.

Methods: We conducted a retrospective analysis of the Premier Database (January 2012 to September 2015) including cholecystectomy patients who received either IV APAP or oral APAP. Differences in LOS, hospitalization costs, mean daily morphine equivalent dose (MED), and potential opioid-related adverse events were estimated. Multivariable logistic regression was performed for the binary outcomes and instrumental variable regressions, using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for continuous outcomes. Models were adjusted for patient demographics, clinical risk factors, and hospital characteristics.

Results: Among 61,017 cholecystectomy patients, 31,133 (51%) received IV APAP. Subjects averaged 51 and 57 years of age, respectively, in the IV and oral APAP cohorts. In the adjusted models, IV APAP was associated with 0.42 days shorter LOS (95% CI?=?–0.58 to –0.27; p?p?p?=?.0005), and lower rates of respiratory depression (odds ratio [OR]?=?0.89, 95% CI?=?0.82–0.97; p?=?.006), and nausea and vomiting (OR?=?0.86, 95% CI?=?0.86–0.86; p?Conclusions: In patients having cholecystectomy, the addition of IV APAP to perioperative pain management is associated with shorter LOS, lower costs, reduced opioid use, and less frequent nausea/vomiting and respiratory depression compared to oral APAP. These findings should be confirmed in a prospective study comparing IV and oral APAP.     

我院静脉药物调配中心人力资源配置合理性分析

合理的人力资源配置能够极好的提高工作效率,本文通过秒表直接测量及访谈的方法测定标准工时,利用标准工时与理论工时的比值测算出员工数量及人员结构,对我院静脉药物调配中心人力资源配置的合理性进行分析,完善人力资源配置,提高工作效率。     

Perinatal mortality and one-year infant morbidity.

Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.     

Visits to office-based physicians in the United States for medication-related morbidity.

OBJECTIVE: To examine the prevalence, nature, demographics, and resource use associated with visits to office-based physicians in the United States during 1995 for medication-related morbidity. DESIGN: A nationwide cross-sectional survey of ambulatory care visits to physician offices, based on data from the National Center for Health Statistics' 1995 National Ambulatory Medical Care Survey. SETTING: Physician office-based settings in the United States. PATIENTS: Patients visiting office-based physicians for principal diagnoses of adverse effect of medications (ICD-9-CM E-code 930.00-947.9). MAIN OUTCOME MEASURES: Weighted measures of prevalence, nature, demographics, and resource use associated with visits related to adverse effects of medications. RESULTS: An estimated 2.01 million (95% confidence interval, 1.69 to 2.34 million) visits for medication-related morbidity were made to office-based physicians in the United States during 1995, representing an annual rate of 7.70 visits per 1,000 persons. Medication-related visit rates were greater in women, in patients between 65 and 74 years of age, and in the Midwest. The most frequently cited reasons for medication-related visits were skin rash, nausea, and shortness of breath. The therapeutic agents responsible for medication-related visits were most often hormone and synthetic substitutes (13.32%), antibiotics (11.55%), and cardiovascular drugs (9.30%). Medication-related visits most often involved diagnostic services and medication therapy. The majority included instructions for a scheduled follow-up, and fewer than 1% resulted in hospital admission. CONCLUSION: Medication-related ambulatory care utilization can pose a significant burden on health care resources unless specific strategies are initiated to control medication-related problems. The provision of pharmaceutical care can play an important role in reducing medication-related problems and associated health care costs.     

Status quo of resource allocation of Chinese grass-roots food and drug administrations: from 2011 to 2016

County grass-root food and drug administrations (CGFDA) undertake the front-line supervision of food and drug safety, whose resource allocation is vitalto the regulation efficiency and performance. In this article, we aimed to analyze the status quo of resource allocation of CGFDA from the aspects of regulatory organization, staff, funding and equipment using officialpanel data from 2011 to 2016. The results illustrated that the total amount of regulatory resources of CGFDA was increased annually, reaching a rather large scale. However, many problems still existed in its allocation. Therefore, a series of measures should be taken to optimize the resource allocation of CGFDA, such as improving the network of institutional CGFDA, increasing the recruitmentrequirements on educational level and major, reallocating the structure of resources and guaranteeing the resource demand in less-developed areas.