Rational planning or muddling through? Resource allocation in the N.H.S

Regulation of vascular endothelial cell growth factor expression in mouse mammary tumor cells by the EP2 subtype of the prostaglandin E2 receptor

Prostaglandin E(2) (PGE(2)), a major metabolite of the cyclooxygenase pathway in the mammary gland, induces angiogenesis during mammary tumor progression. To better define the molecular mechanisms involved, we examined the role of the G protein-coupled receptors (GPCR) for PGE(2) in mammary tumor cell lines isolated from MMTV-cyclooxygenase-2 (COX-2) transgenic mice. Expression of the EP2 subtype of the PGE(2) receptor was correlated with the tumorigenic phenotype and the ability to induce vascular endothelial growth factor (VEGF). Overexpression of EP2 by adenoviral transduction into EP2-null cells resulted in the induction of VEGF expression in response to PGE(2) and CAY10399, an EP2 receptor agonist. The induction of VEGF by the EP2 receptor did not require the hypoxia inducible factor (HIF)-1alpha pathway, MAP kinase pathway, or phosphoinositide-3-kinase/Akt pathway, but required the cAMP/protein kinase A pathway. These results suggest that EP2 receptor is a critical element for PGE(2) mediated VEGF induction in mouse mammary tumor cells.

Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario

Maintaining or improving the welfare of the population is a complex issue involving individual and collective actions and institutions. Despite questions regarding the relevance of health care systems to these aims, they remain vital policy and treatment arenas with respect to curative and preventative regimes. As a component of social welfare, health care resources should be distributed equitably, according to need for health care. This paper evaluates alternative indicators of health status within Ontario against self-reported health as a means of allocating health care resources. Proxies of need for health care include standardized mortality ratios (based on the population aged 0-64) and a socioeconomic based indicator. Mortality indicators are found to be more closely correlated with self-reported health status than the socioeconomic indicator, suggesting that mortality is better able to reflect variations in health status and health care needs.

A needs-based methodology for allocating health care resources in Ontario, Canada: development and an application

In an attempt to limit its health care expenditures, Ontario is, as one option, exploring the possibilities of a capitated system for service delivery payments as opposed to the present mixture of global budgets and fee-for-service. After reviewing the literatures on capitation (primarily American) and on resource allocation (primarily British), the paper sets out to establish a capitation rate, based on 'need' and not prior use, for a range of health services in the northern Ontarian community of Fort Frances-Rainy River. The difficulties and limitations of the needs-based approach are explored. The results reported show the setting of the local population characteristics against provincial average health care utilization data to generate expected use rates, which are then adjusted for need and other factors, particularly relative costs and sparsity. Finally these adjusted rates are applied to current provincial expenditures to derive a target share. This target is then expressed in relation to the planning population to derive the capitation rate.

General and specific factors in the explanation of regional variation of hospital admission rates: policy consequences for Belgium and the Netherlands

The analysis of regional variations in hospital admission rates for Belgium and the Netherlands shows that the available number of hospital beds together with the health status of the population (roughly indicated by age-adjusted mortality rates) are common factors to influence these admissions in spite of the fundamental differences between the health care systems of both countries. Further analysis shows that in Belgium the relative number of providers of ambulatory care (general practitioners, internists, paediatricians and gynaecologists) influences the residual admission coefficients negatively. Policy consequences of these findings are discussed. The recent adaptation of the Belgian Hospital Act that enables closure of existing hospitals for planning reasons is hailed with satisfaction. The importance of Roemer's Law--'a bed build is a bed filled'--is illustrated once again by this analysis.

The definition and identification of need for health care

Some definitions of need for health care as a basis of planning health services are discussed. A model proposed by Donabedian (1974) relating need to resources is used to consider the problems faced by the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976). The paper concludes that need should be defined in relation to the procedures available to meet it and the resources that permit those procedures to be used. The procedures include the whole gamut of prevention and screening, cure and care, research and development. This necessarily raises moral and ethical issues which stretch beyond the limits of medicine and concern patients, their relatives, and the public in general. Neither the medical profession nor the lay public can be expected to help define need for health care unless they understand the underlying issues. This is a challenge to those responsible for professional and public education.