Practical Applications for Resource Allocation

by Michael Erdek, MD, MA

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    00:01 Now that we've discussed some of the philosophical background for the concept of resource allocation, let's go ahead and turn this into how we look at practical applications for this practice of resource allocation.

    00:12 So, one of the things that is helpful to look at is the AMA opinion that has been rendered on the allocation of limited medical resources. The opinion reads as such.

    00:24 A physician has a duty or even any clinician has a duty that he or she can for the benefit of the individual patient.

    00:30 Policies for allocating limited resources have the potential to limit the ability of physicians to fulfill this obligation to patients? This essentially really drills down to the concept of the respect for the individual patient and that this is not lost in a greater societal concern.

    00:48 Physicians have a responsibility therefore to participate and to contribute their professional expertise in order to safeguard the interest of patients in decisions made at the societal level regarding allocation or the rationing of health resources.

    01:04 One must not lose this concern for the individual patient.

    01:09 With regard to the AMA opinion on the provision of adequate healthcare, it reads as such in determining whether a particular procedure or treatment needs to be included in the adequate level of healthcare the American Medical Association code of medical ethics opinions on allocating medical resources recommends consideration of the following five ethical principles.

    01:29 The first of these is the degree of benefit and this is obviously the difference in outcome between treatment and no treatment.

    01:37 The second is the likelihood of benefit. The third is the duration of benefit.

    01:44 The fourth is the cost of the treatment. And then, finally, is the number of people who will benefit.

    01:49 And this refers to the fact that a treatment may benefit the patient and others who come in contact with the patient.

    01:56 This may be seen in a case of a vaccination or an anti-microbial drug which limits the spread of a disease.

    02:03 Let's look at these in each in a little bit more detail. So, first, was the degree of benefit.

    02:07 These criteria prioritize patients who are assessed to have a greater likelihood of benefiting from a treatment.

    02:14 Now, this is important that we look also at the quality of life in addition to the mere years added when we consider degree of benefit.

    02:25 The second and third concepts were both the likelihood and the duration of benefit.

    02:29 Let's take a look at these.

    02:30 These criteria apply particularly when there is a scarcity of resource and when that resource scarcity changes.

    02:38 So, for example, we may have in the case of a pandemic, very few ventilators but then, ventilators become more abundant as vaccination, for example, becomes available.

    02:47 When resources are particularly scarce, priority needs to be given to the sickest patients until the scarcity of the situation improves.

    02:56 However, when consideration is given to the sickest patients, one must balance the sickness of the patient with the concept of utility.

    03:05 So, not every very sick patient necessarily gets a resource just because they're sick because we assess the other side of the coin as well as the futility that may be involved.

    03:16 So, what is medical futility? Well, futility of care when allocating resources is a judgment decision and this is in fact, a judgement that further medical treatment of a patient would not have useful or successful results.

    03:28 One can assume there's a degree of subjectivity here and this is where ethics committees or groups of people making decisions together can be important so that one particular bias does not overrule that of others.

    03:41 Let's move on to the fourth of these concepts and that is the amount and the expense of resources required that is the costs.

    03:47 Now, this cost of benefit is a key issue and this is the cost that is achieved by the healthcare intervention especially when resources are limited.

    03:57 This approach tends to favor resources which are allocated to less expensive treatments or services providing the greatest benefit.

    04:05 So, either those which don't cause much money or those which have some cost associated with them but which exhibit a great degree of benefit.

    04:13 Thirdly, this may be a treatment that produces a large benefit for a small number of people or alternatively, a small benefit for a large number of patients.

    04:25 We can look at this in one way here in particular.

    04:27 So, when resources are scarce, they may be allocated to those who will require less of the resource.

    04:33 This maximizes the number of patients who could benefit from this resource.

    04:39 Finally, let's look at the number of people who benefit.

    04:41 The purpose of this resource allocation system is to optimize the use of limited resources to provide maximum benefit on a societal level.

    04:50 But remember, this is kept in balance with our obligation to treat the individual patient.

    About the Lecture

    The lecture Practical Applications for Resource Allocation by Michael Erdek, MD, MA is from the course Resource Allocation.

    Included Quiz Questions

    1. Likelihood of benefit
    2. Percentage of people harmed
    3. Degree of deficit
    4. Length of deficit
    5. Percentage of unaffected people
    1. Degree of detriment
    2. Number of people who benefit
    3. Duration of benefit
    4. Likelihood of benefit
    5. Cost of treatment
    1. The judgment that further medical treatment of a patient would not have useful or successful results
    2. The judgment favoring resource allocation for less expensive treatments
    3. The judgment favoring resource allocation for more expensive treatments
    4. The judgment providing the maximum benefit on a societal level
    5. The judgment providing the minimum detriment on a societal level

    Author of lecture Practical Applications for Resource Allocation

     Michael Erdek, MD, MA

    Michael Erdek, MD, MA

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