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Distributing medical resources

An application of cooperative bargaining theory to an allocation problem in medicine

Series:

Antje Köckeritz

Allocating scarce medical resources has become an important topic in public discussion. In the German statutory health system we are facing a situation of lacking adequate funds for all needs. The financial restrictions force us to use resources wisely. This emphasizes the need of general allocation rules and criteria applied in medical allocation situations. The purpose of this work is to implement and interpret properties of cooperative bargaining theory to special allocation situations in medicine. The author shows how the concepts of Nash and Kalai/Smorodinsky can be applied to a medical allocation problem and discusses implications of their properties and solutions for the German health system.

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5 Different types of monotonicity in a cooperative bargaining model of distributing medical resources

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5.1 Introduction Allocating medical budgets among hospital departments can be tough, especially, when the budget is sufficient to give full treatment to each individual group yet not to all. For example, we have a medical allocation situation in which two patients groups compete over medical resources based on individual claims. Both groups differ in the type of disease, number of patients and medical quantity claimed. Patients in one group are identical with respect to type of disease and medical quantity needed to treat. In more detail, a large group of surgery patients without any other disorder stands face to face with a small group of hemophilia patients who need special medical treatment under surgery which is extremely expensive. So a large group of patients with small individual medical claim and a small group with an extremely high individual claim compete for scarce medical resources. Imagine that in preliminary bargaining process an agreement on what share of the budget each group receives has been achieved. Since the budget is restricted not all patients may be treated fully according to their claims. In fact, we allow partial treatment, that may relate discussed measures in chapter 4 such as postponing surgeries. In addition, we now examine how changes in the initial conditions affect the solution. Compared to the initial situation either the number of patients that claim treatment or patients’ individual claims or the amount of medical resources available has changed. In our example of surgery patients, we may experience e.g., that more...

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