From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

Objectives Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria and their frequency reported in the literature on healthcare decisionmaking. Method An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing multicriteria tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured. Results Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 40 studies included. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 360 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (32 times), efficacy/effectiveness (29), stakeholder interests and pressures (28), cost-effectiveness (23), strength of evidence (20), safety (19), mission and mandate of health system (19), organizational requirements and capacity (17), patient-reported outcomes (17) and need (16). Conclusion This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-settin

Logistics outsourcing and 3PL selection: A Case study in an automotive supply chain

Outsourcing logistics functions to third-party logistics (3PL) providers has been a source of competitive advantage for most companies. Companies cite greater flexibility, operational efficiency, improved customer service levels, and a better focus on their core businesses as part of the advantages of engaging the services of 3PL providers. There are few complete and structured methodologies for selecting a 3PL provider. This paper discusses how one such methodology, namely the Analytic Hierarchy Process (AHP), is used in an automotive supply chain for export parts to redesign the logistics operations and to select a global logistics service provider

Solving multiple-criteria R&D project selection problems with a data-driven evidential reasoning rule

In this paper, a likelihood based evidence acquisition approach is proposed to acquire evidence from experts'assessments as recorded in historical datasets. Then a data-driven evidential reasoning rule based model is introduced to R&D project selection process by combining multiple pieces of evidence with different weights and reliabilities. As a result, the total belief degrees and the overall performance can be generated for ranking and selecting projects. Finally, a case study on the R&D project selection for the National Science Foundation of China is conducted to show the effectiveness of the proposed model. The data-driven evidential reasoning rule based model for project evaluation and selection (1) utilizes experimental data to represent experts' assessments by using belief distributions over the set of final funding outcomes, and through this historic statistics it helps experts and applicants to understand the funding probability to a given assessment grade, (2) implies the mapping relationships between the evaluation grades and the final funding outcomes by using historical data, and (3) provides a way to make fair decisions by taking experts' reliabilities into account. In the data-driven evidential reasoning rule based model, experts play different roles in accordance with their reliabilities which are determined by their previous review track records, and the selection process is made interpretable and fairer. The newly proposed model reduces the time-consuming panel review work for both managers and experts, and significantly improves the efficiency and quality of project selection process. Although the model is demonstrated for project selection in the NSFC, it can be generalized to other funding agencies or industries.Comment: 20 pages, forthcoming in International Journal of Project Management (2019

iFair: Learning Individually Fair Data Representations for Algorithmic Decision Making

People are rated and ranked, towards algorithmic decision making in an increasing number of applications, typically based on machine learning. Research on how to incorporate fairness into such tasks has prevalently pursued the paradigm of group fairness: giving adequate success rates to specifically protected groups. In contrast, the alternative paradigm of individual fairness has received relatively little attention, and this paper advances this less explored direction. The paper introduces a method for probabilistically mapping user records into a low-rank representation that reconciles individual fairness and the utility of classifiers and rankings in downstream applications. Our notion of individual fairness requires that users who are similar in all task-relevant attributes such as job qualification, and disregarding all potentially discriminating attributes such as gender, should have similar outcomes. We demonstrate the versatility of our method by applying it to classification and learning-to-rank tasks on a variety of real-world datasets. Our experiments show substantial improvements over the best prior work for this setting.Comment: Accepted at ICDE 2019. Please cite the ICDE 2019 proceedings versio

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining ‘success’ and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members

Corruption manual for beginners: "Corruption techniques" in public procurement with examples from Hungary

This paper develops 30 novel quantitative indicators of grand corruption that operationalize 20 distinct techniques of corruption in the context of public procurement. Each indicator rests on a thorough qualitative understanding of rent extraction from public contracts by corrupt networks as evidenced by academic literature, interviews and media content analysis. Feasibility and usefulness of the proposed indicators are demonstrated using micro-level public procurement data from Hungary in 2009-2012. While the prime value of this broad set of indicators is the possibility of combining them into a robust composite indicator of high-level corruption, the high degree of detail also reveals that many regulatory interventions have succeeded in changing the form of corruption, but not its overall incidence

Vaccine implementation: Alaska 2017

Bacterial meningitis is a serious disease that causes permanent dysfunction or death; adolescents and young adults carry the greatest risk. The national Advisory Committee on Immunization Practices (ACIP) has released vaccine recommendations that include incorporation of meningitis vaccine in to the mandatory school vaccine schedule. Throughout the nation, much of legislative policy has made meningitis vaccination a requirement for public school attendance. Alaska does not have such policy; the purpose of the project was to address this policy need. A secondary project goal was to increase community awareness of bacterial meningitis. Project actions were divided into policy advocacy and community awareness. Policy advocacy included the development of a Policy Brief to Persuade designed for the Alaska legislative health care committee members. A legislative survey to assess willingness to incorporate a required meningitis vaccine schedule into existing Alaska vaccine policy was sent electronically with the policy brief. Community awareness interventions included the development of a Meningitis Education Bundle for healthcare professionals and a Protect Alaska’s Future campaign. The education bundle was distributed to local health establishments on Prince of Wales Island and the campaign information was distributed at the 2017 Prince of Wales Community Health Fair. Project outcomes demonstrated a lack of response to the policy survey. Efforts must continue over time with a deliberate plan to gain legislative support for the incorporation of a meningitis vaccination schedule into existing Alaska vaccine policy, as recommended by the ACIP. Community awareness activities at the health fair were successful and should continue

Evaluation of Corporate Sustainability

As a consequence of an increasing demand in sustainable development for business organizations, the evaluation of corporate sustainability has become a topic intensively focused by academic researchers and business practitioners. Several techniques in the context of multiple criteria decision analysis (MCDA) have been suggested to facilitate the evaluation and the analysis of sustainability performance. However, due to the complexity of evaluation, such as a compilation of quantitative and qualitative measures, interrelationships among various sustainability criteria, the assessor’s hesitation in scoring, or incomplete information, simple techniques may not be able to generate reliable results which can reflect the overall sustainability performance of a company. This paper proposes a series of mathematical formulations based upon the evidential reasoning (ER) approach which can be used to aggregate results from qualitative judgments with quantitative measurements under various types of complex and uncertain situations. The evaluation of corporate sustainability through the ER model is demonstrated using actual data generated from three sugar manufacturing companies in Thailand. The proposed model facilitates managers in analysing the performance and identifying improvement plans and goals. It also simplifies decision making related to sustainable development initiatives. The model can be generalized to a wider area of performance assessment, as well as to any cases of multiple criteria analysis