Value for money - recasting the problem in terms of dynamic access prioritisation

Disability and Rehabilitation
William J Taylor, George Laking

Abstract

To develop an approach for achieving value for money in rehabilitation based on dynamic prioritisation of access to services according to individual capacity to benefit. A critical review of economic evaluation and adaptation of a prioritisation method used in determining access to elective surgical services in New Zealand to a rehabilitation context. The cost-effectiveness frontier is not straight but curved, suggesting that some people benefit more from a given intervention than others. An approach that identifies those most likely to benefit from inpatient rehabilitation following stroke (as an example) and enables access in order of capacity to benefit is presented in the context of a quality improvement programme. The approach is operationalised as a prioritisation tool that is dynamic in the sense that is can be reapplied subject to changes in the patient's clinical status. The steps proposed to develop such a tool include qualitative research with expert clinicians, pair-wise comparison of alternative scenarios (1000Minds survey), construction of an economic model of the tool's operation and an observational cohort study to help populate the model and calibrate the tool. A dynamic prioritisation approach to guide access ...Continue Reading

References

Jun 1, 1990·American Journal of Physical Medicine & Rehabilitation·J S OsbergG DeJong
Jan 11, 1997·BMJ : British Medical Journal·D C Hadorn, A C Holmes
Jan 11, 1997·BMJ : British Medical Journal·D C Hadorn, A C Holmes
May 11, 2001·Archives of Physical Medicine and Rehabilitation·D D CardenasS M Gnatz
Mar 11, 2003·Clinical Rehabilitation·Derick T Wade
Mar 15, 2003·Archives of Physical Medicine and Rehabilitation·Mark V JohnstonRoger Fiedler
Mar 10, 2004·Journal of Health Services Research & Policy·Andrew MacCormickBryan Parry
May 3, 2006·Health Economics·George LakingAlastair Fischer
Oct 30, 2007·Archives of Physical Medicine and Rehabilitation·Mark V JohnstonMaureen Greene
Oct 11, 2008·BMJ : British Medical Journal·Norman Daniels, James E Sabin

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