Efficiency, equity, and budgetary policies: informing decisions using mathematical programming.
The standard decision rules of cost-effectiveness analysis either require the decision maker to set a threshold willingness to pay for additional health care or to set an overall fixed budget. In practice, neither are generally taken, but instead an arbitrary decision rule is followed that may not b...
| Publicado en: | Medical Decision Making Vol. 27; no. 2; pp. 128 - 138 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Sage Publications Inc.
Mar/Apr2007
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106010936&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106010936 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0272989X DKI jtl: Medical Decision Making issn: 0272989X maglogo: Y pubinfo: dt: Mar/Apr2007 vid: 27 iid: 2 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 106010936 106010936 2009553509 10.1177/0272989x06297396 NLM17409363 106010936 ppf: 128 ppct: 10 formats: tig: atl: Efficiency, equity, and budgetary policies: informing decisions using mathematical programming. aug: au: Epstein DM Chalabi Z Claxton K Sculpher M sug: subj: Budgets Models, Statistical Resource Allocation Economics Health Care Costs Health Policy Economics Life Table Method Organizational Efficiency Human ab: The standard decision rules of cost-effectiveness analysis either require the decision maker to set a threshold willingness to pay for additional health care or to set an overall fixed budget. In practice, neither are generally taken, but instead an arbitrary decision rule is followed that may not be consistent with the overall budget, lead to an allocation of resources that is less than optimal, and is unable to identify the program that should be displaced at the margin. Recent work has shown how mathematical programming can be used as a generalization of the standard decision rules. The authors extend the use of mathematical programming, first to incorporate more complex budgetary rules about when expenditure can be incurred, and show the opportunity loss, in terms of health benefit forgone, of each budgetary policy. Second, the authors demonstrate that indivisibility in a patient population can be regarded as essentially a concern for horizontal equity and represent this and other equity concerns as constraints in the program. Third, the authors estimate the different opportunity costs of a range of equity concerns applied to particular patient populations, and when imposed on all patient populations. They apply this framework of analysis to a realistic and policy-relevant problem. Key words: cost-effectiveness analysis; cost-benefit analysis; mathematical programming; resource allocation. (Med Decis Making 2007;27:128-137). pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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