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Putting a specific value on human life is important in many contexts and forms part of the basis for many political, administrative, commercial, and personal decisions. Sometimes, the value is set explicitly, sometimes even in monetary terms, but much more often, it is set implicitly through a decision that allows us to calculate the valuation of a life implicit in a certain rule or a certain resource allocation. We also value lives in what looks like a completely different way when we evaluate whether a particular life is being or has been lived well. Both of these ways of valuing are done from an outside or third-person perspective, but there is also a third way of valuing a life which is from the first-person perspective, and which essentially asks how much my life is worth to me. Is there any connection between these different ways of valuing life, and if so what is the connection between them? This paper provides an account of John Harris’ analysis of the value of life and discusses whether it can bridge the gap between first-person and third-person evaluations of the value of life, and whether it can do so in a way that still allows for resource allocation decisions to be made in health care and other sectors.
Healthcare disinvestment requires multi-level decision-making, and early stakeholder engagement is essential to facilitate implementation and acceptance. This study aimed to explore the perceptions of Malaysian healthcare stakeholders to disinvestment initiatives as well as identify disinvestment activities in the country.
Methods
A cross-sectional online survey was conducted from February to March 2023 among Malaysian healthcare stakeholders involved in resource allocation and decision-making at various levels of governance. Response frequencies were analyzed descriptively and cross-tabulation was performed for specific questions to compare the responses of different groups of stakeholders. For free-text replies, content analysis was used with each verbatim response examined and assigned a theme.
Results
A total of 153 complete responses were analyzed and approximately 37 percent of participants had prior involvement in disinvestment initiatives. Clinical effectiveness and cost-effectiveness ranked as the most important criteria in assessment for disinvestment. Surprisingly, equity was rated the lowest priority despite its crucial role in healthcare decision-making. Almost 90 percent of the respondents concurred that a formal disinvestment framework is necessary and the importance of training for the program’s successful implementation. Key obstacles to the adoption of disinvestment include insufficient stakeholder support and political will as well as a lack of expertise in executing the process.
Conclusions
While disinvestment is perceived as a priority for efficient resource allocation in Malaysian healthcare, there is a lack of a systematic framework for its implementation. Future research should prioritize methodological analysis in healthcare disinvestment and strategies for integrating equity considerations in evaluating disinvestment candidates.
The primary objectives of this umbrella review were to (a) quantify the relative importance, of “severity” and “rarity” criteria in health resource allocation; and (b) analyze the contextual factors influencing the relative importance. The secondary objective was to examine how “severity” and “rarity” criteria are defined.
Methods
Searches were carried out in PubMed and Embase to identify eligible systematic reviews. Quality appraisal of systematic reviews was undertaken. From identified systematic reviews, primary studies were extracted and further screened for eligibility. The inclusion of severity and rarity criteria and their respective weights in primary studies were examined. Descriptive and regression analyses were performed.
Results
Twenty-nine systematic reviews were screened, of which nine met the inclusion criteria. Primary studies included in these systematic reviews were retrieved and screened, resulting in forty articles included in the final analysis. Disease severity was more frequently considered (n = 29/40) than disease rarity (n = 23/40) as an evaluation criterion. Out of all cases where both were included as evaluation criteria, disease severity was assigned higher weights 84 percent of the time (n = 21/25).
Conclusions
Our review found consistent evidence that disease severity is more relevant and preferred to rarity as a priority-setting criterion albeit constraints in statistical analysis imposed by limited sample size and data availability. Where funding for rare diseases is concerned, we advocate that decision-makers be explicit in clarifying the significance of disease severity and/or rarity as a value driver behind decisions. Our findings also reinforce the relevance of disease severity as a criterion in priority setting.
The aim of this review is to identify, evaluate, and graphically display gaps in the literature related to scarce health resource allocation in humanitarian aid settings.
Methods
A systematic search strategy was utilized in MEDLINE (via Ovid), Scopus, EMBASE, CINAHL Complete, and ProQuest Central. Articles were reviewed by 2 reviewers with a third reviewer remedying any screening conflicts. Articles meeting inclusion criteria underwent data extraction to facilitate evaluation of the scope, nature, and quality of experience-based evidence for health resource allocation in humanitarian settings. Finally, articles were mapped on a matrix to display evidence graphically.
Results
The search strategy identified 6093 individual sources, leaving 4000 for screening after removal of duplicates. Following full-text screening, 12 sources were included. Mapping extracted data according to surge capacity domains demonstrated that all 4 domains were reflected most of all the staff domain. Much of the identified data was presented without adhering to a clear structure or nomenclature. Finally, the mapping suggested potential incompleteness of surge capacity constructs in humanitarian response settings.
Conclusions
Through this review, we identified a gap in evidence available to address challenges associated with scarce resource allocation in humanitarian settings. In addition to presenting the distribution of existing literature, the review demonstrated the relevance of surge capacity and resource allocation principles underpinning the developed framework.
A surge of pediatric respiratory illnesses beset the United States in late 2022 and early 2023. This study evaluated within-surge hospital acute and critical care resource availability and utilization. The study aimed to determine pediatric hospital acute and critical care resource use during a respiratory illness surge.
Methods
Between January and February 2023, an online survey was sent to the sections of hospital medicine and critical care of the American Academy of Pediatrics, community discussion forums of the Children’s Hospital Association, and PedSCCM—a pediatric critical care website. Data were summarized with median values and interquartile range.
Results
Across 35 hospitals with pediatric intensive care units (PICU), increase in critical care resource use was significant. In the month preceding the survey, 26 (74%) hospitals diverted patients away from their emergency department (ED) to other hospitals, with 46% diverting 1-5 patients, 23% diverting 6-10 patients, and 31% diverting more than 10 patients. One in 5 hospitals reported moving patients on mechanical ventilation from the PICU to other settings, including the ED (n = 2), intermediate care unit (n = 2), cardiac ICU (n = 1), ward converted to an ICU (n = 1), and a ward (n = 1). Utilization of human critical care resources was high, with PICU faculty, nurses, and respiratory therapists working at 100% capacity.
Conclusions
The respiratory illness surge triggered significant hospital resource use and diversion of patients away from hospitals. Pediatric public health emergency-preparedness should innovate around resource capacity.
Phenological studies for Cuban bulrush [Oxycaryum cubense (Poepp. & Kunth) Lye] have been limited to the monocephalous form in Lake Columbus (Mississippi). Accordingly, there is little available information on potential phenological differences among O. cubense forms (monocephalous vs. polycephalous) and populations in other geographic locations in the United States. Therefore, seasonal patterns of biomass and starch allocation in O. cubense were quantified from two populations in Lake Columbus on the Tennessee-Tombigbee Waterway in Mississippi (monocephalous), two populations from Lake Martin in Louisiana (polycephalous), and two populations from Orange Lake in Florida (polycephalous). Monthly samples of O. cubense inflorescence, emergent, and submersed tissue were harvested from two plots per state from October 2021 to September 2022. During monthly data collection, air temperature and photoperiod were recorded. Starch allocation patterns were similar among all sites, with starch storage being less than 1.5% dry weight for all plant tissues. Biomass was greatest in Lake Columbus (monocephalous; 600.7 g dry weight [DW] m−2) followed by Lake Martin (polycephalous; 392.3 g DW m−2) and Orange Lake (polycephalous; 233.85 g DW m−2). Peak inflorescence biomass occurred in the winter for the Lake Martin and Orange Lake populations and in the summer for the Lake Columbus population. Inflorescence biomass in Lake Columbus had a positive relationship (r2 = 0.53) with warmer air temperatures. Emergent and submersed biomass generally had negative relationships with both photoperiod and temperature (r2 = 0.02 to 0.77) in all sites. Peak biomass was also negatively related to temperature and photoperiod. Results from this study indicate that there are differences in biomass allocation between the two growth forms of O. cubense and that growth can occur at temperatures below freezing. Low temperature tolerance may allow this species to expand its range farther north than previously suspected.
Current escalation of natural disasters, pandemics, and humanitarian crises underscores the pressing need for inclusion of disaster medicine in medical education frameworks. Conventional medical training often lacks adequate focus on the complexities and unique challenges inherent in such emergencies. This discourse advocates for the integration of disaster medicine into medical curricula, highlighting the imperative to prepare health-care professionals for an effective response in challenging environments. These competencies encompass understanding mass casualty management, ethical decision-making amidst resource constraints, and adapting health-care practices to varied emergency contexts. Therefore, we posit that equipping medical students with these specialized skills and knowledge is vital for health-care delivery in the face of global health emergencies.
This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies.
Method
Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494).
Results
The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were “Need for intervention” and “Intervention outcomes.” The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples.
Conclusions
A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.
The allocation of resources is a crucial part of political decision-making in healthcare, but explicit priorities are rarely set when resources are distributed. Two areas that have received some attention in research about legitimacy and priority-setting decisions in healthcare are the role of technical expert agencies as mediating institutions and the role of elected politicians. This paper investigates a political priority-setting advisory committee within a regional authority in Sweden. The aim is to explore how a political body can serve as a mediating institution for priority-setting in healthcare by disentangling the arrangements of its work in terms of what role it performs in the organisation and what it should do. The findings illustrate that promoting the notion of explicit priority-setting and the political aspects inherent in priority-setting in political healthcare management can contribute to consolidating political governance and leadership. There is, however, a complex tension between stability and conflicting values which has implications for the role of politicians as citizens' democratic representatives. This paper enhances our understanding of the role of mediating institutions and political properties of healthcare priority-setting, as well as our understanding of political and democratic healthcare governance in local self-government.
Marginalist revolution tended to ignore equity questions because it focused on the efficient allocation of resources and not on the fair distribution of income and wealth. The concept of Pareto Optimum was generally endorsed by classical economists. It was opposed by those with socialist views. Marginalist principles stressed that the utilities of different individuals could not be compared. Substitution effects were emphasized over income effects. This had strong implications for policies, including tax and spending policies. The view was that comparisons should be based on science and not on vague intuition. Forced distribution could have negative implications for the allocation of resources and for the performance of the economy. The concept of justice had been vague in history and remained different between socialists and classical economists. For socialists there was the Marxist and the milder Catholic branch. The Marxist branch stressed income equality while the Catholic one tolerated some inequality, as long as it was justified by different effort and ability. The Marxist version would characterize the 1917 Russian Revolution. Tax levels were still low and public debt was expensive.
Health-care systems within most countries are resource-limited – budgets are finite and not every service one would like to provide can be funded. In publicly funded health systems, those responsible for procuring health-care need to be able to explain how taxpayers’ money has been spent. Decisions are made at both individual patient and population levels. At an individual level, the decision might be: which statin should this patient get a prescription for to lower her blood cholesterol? At a population level, the decision might be: will a health and social care commissioning organization purchase a heart-failure specialist nurse or an additional sexual health clinic?
This chapter focuses on how such decisions are made and considers a framework for priority setting, a discussion of what factors should be taken into account when comparing options, a consideration of basic health economic concepts, and an overview of ethical principles which influence decisions.
An essential feature of human progress is the use of different modes of learning so agents acquire the appropriate behaviour to survive in a changing environment. Learning may result from agents who discover new knowledge on their own (individual learning), or imitate the behaviour of others (social learning). Social learning is less costly than discovery, but imitation might yield no benefit. Early theoretical models of a population consisting of purely individual and purely social learners found that both types are present in an evolutionary equilibrium. However, the presence of social learners did not provide any improvement to the average population fitness. Subsequent research showed that the presence of social learners could improve the average population fitness, provided that the pure characterisation of the agents’ learning is relaxed. We return to the pure conceptualisation of agents to challenge an assumption in the early work: agents were guaranteed enough resources to perform their desired learning. We show that, if the resources an agent receives are uncertain, this turns social learning into a source of fitness improvement at the population level. Perhaps counter-intuitively, uncertain provision of resources prompts an increase in the proportion of the population that pursues the costlier individual learning activity in equilibrium.
In an era of hypercompetition, research and development (R&D) investments are vital for organizations to stay competitive. This microlevel study draws on dynamic managerial capability (DMC) theory to explore the mechanisms contributing to competitive advantages. It posits that DMCs enhance firm performance by increasing R&D spending, and explores the moderating role of slack resources due to their effect on resource availability. Employing hierarchical regression analysis and bootstrapping methods on a longitudinal sample comprising 31 German DAX firms, the findings robustly demonstrate that DMCs facilitate firm performance by fostering R&D expenditures and confirm the moderating effect of specific slack resources. However, only internal but not external slack resources amplify the relationship between DMCs and R&D intensity. Overall, this study emphasizes the critical role of managers’ microlevel capabilities in determining firm performance and sheds light on how different slack resources influence the relationships between DMCs, R&D intensity, and firm performance.
This note corrects an error in the formula to obtain the Whittle index using the Sherman–Morrison formula in Akbarzadeh and Mahajan (2022). Also, some other minor typos are highlighted.
Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.
Pandemics generate such a significant demand for care that traditional triage methods can become saturated. Secondary population-based triage (S-PBT) overcomes this limitation. Although the coronavirus disease (COVID-19) pandemic forced S-PBT into operation internationally during the first year of the pandemic, Australian doctors were spared this responsibility. However, the second wave of COVID-19 provides an opportunity to explore the lived experience of preparing for S-PBT within the Australian context.
The aim of this study is to explore the lived experience of preparing to operationalize S-PBT to allocate critical care resources during Australia’s second wave of COVID-19 in 2020.
Methods:
Intensivists and emergency physicians working during the second Victorian COVID-19 surge were recruited by purposive non-random sampling. Semi-structured interviews were hosted remotely, recorded, transcribed, and coded to facilitate a qualitative phenomenological analysis.
Results:
Six interviews were conducted with an equal mix of intensivists and emergency doctors. Preliminary findings from a thematic analysis revealed 4 themes: (1) threat of resources running; (2) informed decision requiring information; (3) making decisions as we always do; and (4) a great burden to carry.
Conclusion:
This is the first description of this novel phenomenon within Australia and, in doing so, it identified a lack of preparedness to operationalize S-PBT during the second wave of COVID-19 in Australia.
Inclusion and exclusion strategies for allocation of scarce goods involve different processes. The conditions under which one strategy is chosen in favor of the other, however, have not been fully explicated. In the present study, decision makers chose a single strategy after reading through descriptions of 16 potential organ recipients; they then narrowed the list of transplant candidates. Most liberals chose to use exclusion under conditions of abundance and inclusion under scarcity. In contrast, conservatives preferred an inclusion strategy under abundance and exclusion (though not significantly) under scarcity. Theoretical implications as well as ongoing work in inclusion-exclusion strategy choice, political ideology, and distributive justice are discussed.
This paper investigates how the numerosity bias influences individuals’ allocation of resources between themselves and others, using the backdrop of the traditional dictator game. Across four studies including both hypothetical and real exchanges of money, we show that the form of the numerical value representing the quantity of the resource (e.g., $20 vs 2000 cents) systematically biases the decision-maker to perceive the quantity s/he is thinking of allocating as being “less than adequate” or “more than adequate”. Essentially, such a biased perception of adequacy with respect to the quantity of the resource consequently influences the decision-maker’s final allocation decision. We attribute this systematic bias to the “numerosity” of the resource. We find that bigger numerical values representing quantity (e.g., 2000 cents) bias decision-makers to over-infer the quantity, thus inducing them to allocate less to the entities they are focusing on.
Economic games involving allocation of resources have been a useful tool for the study of decision making for both psychologists and economists. In two experiments involving a repeated-trials game over twenty opportunities, undergraduates made choices to distribute resources between themselves and an unseen, passive other either optimally (for themselves) but non-competitively, equally but non-optimally, or least optimally but competitively. Surprisingly, whether participants were told that the anonymous other was another student or a computer did not matter. Using such terms as “game” and “player” in the course of the session was associated with an increased frequency of competitive behavior. Males were more optimal than females: a gender-by-incentive interaction was found in the first experiment. In agreement with prior research, participants whose resources were backed by monetary incentive acted the most optimally. Overall, equality was the modal strategy employed, although it is clear that motivational context affects the allocation of resources.