The aim of this chapter is to explore the factors that health managers adopt when making decisions on how to allocate limited healthcare resources. The objective is to increase knowledge and understanding of decision making processes at the macro, meso, and micro levels and priority setting. An examination of current healthcare decision-making processes used for resource allocation around the world highlights the disparities in models and approaches and the often ad hoc nature of decisions made. A description of the allied health workforce highlights the size and significance of this workforce and why understanding decisions made in regards to allied health resources is of importance. Issues of access and equity are also considered in relation to notions of fairness and efficacy in relation to health outcomes.
TopResource Allocation Decisions In Healthcare
Resource allocation decisions are made at all levels within the healthcare system (Klein, 1993). Macro level decisions include decisions that affect structures and processes at the policy level to fit with the health needs of populations across the continuum of care, e.g. the central government setting the overall budget for the health system. Meso level decisions include organisational decisions such as determining the services provided, coordination of care for particular groups of patients or the purchase of appropriate equipment to support a specific service (Adams, Jones, Lefmann, & Sheppard, 2016). Micro level decisions include the management of individuals at the service level including both clinical decision making (Klein & Maybin, 2012) and service level decision making (Adams, Jones, Lefmann, & Sheppard, 2016; Bærøe, 2008). The effects of macro level decisions filter down the decision-making chain, shaping the organizational level and service/clinical level decisions being made as seen in Figure 1.
Figure 1. Levels of healthcare decision-making
Decisions made at the macro level can often be from politically charged topics (Sabik & Lie, 2008). At the meso level, there is little evidence to guide decision-making in regards to service priorities of a health care system as a whole (Imison, Sonola, Honeyman, & Ross, 2014), with most approaches focusing on a single intervention or condition (Angelis, Kanavos, & Montibeller, 2017). Previous authors have labeled this kind of decision-making as an ad hoc process with intuitive or heuristic elements and has been more about “muddling through” (Figure 2) rather than explicitly following an operational procedure (Angelis, Kanavos, & Montibeller, 2017; Baltussen & Niessen, 2006; Parsons, 2002; Yancey, Cole, & McCarthy, 2010).