Formula-Based Resource Allocation in Health Care Services

Öz

Financing is a process that covers both resource production and resource allocation and flow. Resource allocation is one of the important stages of the financing process and governments are looking for ways of fair and balanced distribution of resources. In healthcare services, there are various resource allocation methods such as fee-for-service, per capita, per case, daily, bonus, and annual fixed payments, and these methods are used together in health systems. One of these techniques is the formula-based resource allocation method. Formula-based resource allocation, which aims to provide equal resources to all individuals and is based on rational approaches, is expressed as the transfer of resources from the resource allocating institution or organisation to health institutions by using mathematical approaches. It is stated that formula-based resource allocation methods, which offer a more holistic perspective on the needs of individuals, can facilitate health service planning. Formulas ensure effective and productive resource allocation and have an impact on patients' access to health services, meeting their needs and the quality of health services provided. With formula-based resource allocation, resources can be allocated in a fair and transparent manner.

Anahtar Kelimeler

• Reimbursement Methods
• Resource Allocation
• Formula Based Financing
• Fair Funding
• Health Care Services

Sağlık Hizmetlerinde Formül Tabanlı Kaynak Tahsisi

Öz

Finansman hem kaynak üretimini hem de kaynak tahsisi ve akışını kapsayan bir süreçtir. Kaynak tahsisi finansman sürecinin önemli aşamalarından biridir ve hükümetler kaynakların adil ve dengeli dağıtımının yollarını aramaktadır. Sağlık hizmetlerinde hizmet başına, kişi başına, vaka başına, günlük, bonus ve yıllık sabit ödeme gibi birçok kaynak tahsis yöntemi bulunmaktadır ve bu yöntemler sağlık sistemlerinde bir arada kullanılmaktadır. Bu tekniklerden biri de formül tabanlı kaynak tahsis yöntemidir. Tüm bireylere eşit kaynak sağlama amacı güden ve rasyonel yaklaşımlara dayanan formül tabanlı kaynak tahsisi, matematiksel yaklaşımlar kullanılarak kaynak tahsis eden kurumdan sağlık kuruluşlarına kaynak aktarımı olarak ifade edilmektedir. Bireylerin ihtiyaçlarına daha bütüncül bir bakış açısı sunan formül tabanlı kaynak tahsis yöntemlerinin sağlık hizmeti planlamasını kolaylaştırabileceği belirtilmektedir. Formüller, kaynak tahsisinin etkili ve verimli şekilde gerçekleşmesini sağlamakta ve hastaların sağlık hizmetine erişimine, ihtiyaçlarının karşılanmasına ve sunulan sağlık hizmetinin kalitesine etki etmektedir. Formül tabanlı kaynak tahsisi ile kaynaklar, adil ve şeffaf bir şekilde tahsis edilebilmektedir.

Anahtar Kelimeler

• Geri Ödeme Yöntemleri
• Kaynak Tahsisi
• Formül Tabanlı Finansman
• Adil Finansman
• Sağlık Hizmetleri

Kaynakça

1. ANSELMI, L., LAGARDE, M., & HANSON, K. (2015). Equity in the allocation of public sector financial resources in low-and middle-income countries: a systematic literature review. Health policy and planning, 30(4), 528-545.
2. ATASEVER, M. (2014). Türkiye sağlık hizmetlerinin finansmanı ve sağlık harcamalarının analizi 2002-2013 dönemi. Strateji Geliştirme Başkanlığı.
3. BLEWETT, L. A., & DAVERN, M. (2007). Distributing State Children's Health Insurance Program funds: a critical review of the design and implementation of the funding formula. Journal of Health Politics, Policy and Law, 32(3), 415-455.
4. BUEHLER, J. W., & HOLTGRAVE, D. R. (2007). Challenges in defining an optimal approach to formula-based allocations of public health funds in the United States. BMC public health, 7, 1-8.
5. CARR-HILL, R. A., HARDMAN, G., MARTIN, S., PEACOCK, S., SHELDON, T. A., & SMITH, P. C. (1997). A new formula for distributing hospital funds in England. Interfaces, 27(1), 53-70.
6. ÇELİK, Y. (2019). Sağlık ekonomisi. Siyasal Kitabevi.
7. DIXON, J., SMITH, P., GRAVELLE, H., MARTIN, S., BARDSLEY, M., RICE, N., GEORGHIOU, T., DUSHEIKO, M., BILLINGS, J., LORENZO, M. D., & SANDERSON, C. (2011). A person based formula for allocating commissioning funds to general practices in England: Development of a statistical model. BMJ (Clinical research ed.), 343, 1-16.
8. GIBBS, A., SONDALINI, R., & PEARSE, J. (2002). The NSW health resource distribution formula and health inequalities. New South Wales public health bulletin, 13(3), 42-44.

9. GORSKY, M. (2018). Resource allocation for equity in the British National Health Service, 1948–89: an advocacy coalition analysis of the RAWP. Journal of health politics, policy and law, 43(1), 69-108.
10. GURGEL, G. D., LEAL, E. M. M., OLIVEIRA, S. R. D. A., SANTOS, F. D. A. D. S., SOUSA, I. M. C. D., & DIDERICHSEN, F. (2019). Resource allocation for equity in Brazilian health care: A methodological model. Saúde em Debate, 43, 329-340.
11. GÜVERCİN, A., MİL, H., & TARIM, B. (2016). Sağlık hizmetlerinin finansmanı ve Sosyal Güvenlik Kurumu (SGK). Bartın Üniversitesi İİBF Dergisi, 7(13), 80-94.
12. HARKER, R. (2019). NHS funding allocations: Clinical commissioning groups. House of Commons Library.
13. HEALD, D., & GEAUGHAN, N. (1994). Formula funding of UK higher education: rationales, design and probable consequences. Financial Accountability & Management, 10(4), 267-290.
14. JABINE, T. B., LOUIS, T. A., & SCHIRM, A. L. (2001). Choosing the right formula: Initial report. National Research Council.
15. JOHNSTON, B. M., BURKE, S., KAVANAGH, P. M., O'SULLIVAN, C., THOMAS, S., & PARKER, S. (2021). Moving beyond formulae: A review of international population-based resource allocation policy and implications for Ireland in an era of healthcare reform. HRB Open Research, 4(121), 1-26.
16. LEE, K., & GOODMAN, H. (2002). Global policy networks: The propagation of health care financing reform since the 1980s. Cambridge University Press.
17. MAGNUSSEN, J. (2010). Equal access for equal need? Constructing and implementing a capitation-based formula for the distribution of health care resources in Norway. International journal of circumpolar health, 69(5), 448-461.
18. MAHARAJ, Y., ROBINSON, A., & MCINTYRE, D. (2018). A needs-based approach to equitable allocation of district primary healthcare expenditure in North West Province, South Africa. South African Medical Journal, 108(3), 190-196.
19. MCGUIRE, F., REVILL, P., TWEA, P., MOHAN, S., MANTHALU, G., & SMITH, P. C. (2018). Recommendations for the development of a health sector resource allocation formula in Malawi. Centre for Health Economics University of York.
20. MCGUIRE, F., REVILL, P., TWEA, P., MOHAN, S., MANTHALU, G., & SMITH, P. C. (2020). Allocating resources to support universal health coverage: Development of a geographical funding formula in Malawi. BMJ Global Health, 5(9), 1-11.
21. MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION. (2024). Federal medical assistance percentage. Erişim Tarihi: 13.04.2024, https://www.macpac.gov/subtopic/matching-rates/
22. MOSSIALOS, E., DIXON, A., FIGUERAS, J., KUTZIN, J., & WORLD HEALTH ORGANIZATION. (2002). Funding health care: Options for Europe. World Health Organization: Regional Office for Europe.
23. OGDEN, L. L., SELLERS, K., SAMMARTINO, C., BUEHLER, J. W., & BERNET, P. M. (2012). Funding formulas for public health allocations: Federal and state strategies. Journal of Public Health Management and Practice, 18(4), 309-316.
24. PEARSON, M. (2002). Allocating public resources for health: developing pro-poor approaches. DFID Health Systems Resource Centre. Erişim tarihi: 31.12.2024, https://assets.publishing.service.gov.uk/media/57a9d719e5274a0f6c000042/19_Allocating-public-resources-for-health.pdf
25. PENNO, E., GAULD, R., & AUDAS, R. (2013). How are population-based funding formulae for healthcare composed? A comparative analysis of seven models. BMC health services research, 13(1).
26. PUBLIC HEALTH SCOTLAND. (2023). Resource allocation: Formula what is the resource allocation formula?. Erişim tarihi: 13.04.2024, https://publichealthscotland.scot/our-areas-of-work/acute-and-emergency-services/finance-within-the-nhs/resource-allocation-formula/what-is-the-resource-allocation-formula/
27. PRICEWATERHOUSECOOPERS. (2018). Healthcare: Funding for value. Erişim tarihi: 13.04.2024, https://www.pwc.com.au/publications/pdf/funding-thought-leadership-18apr18.pdf
28. RADINMANESH, M., EBADIFARD AZAR, F., AGHAEI HASHJIN, A., NAJAFI, B., & MAJDZADEH, R. (2021). A review of appropriate indicators for need-based financial resource allocation in health systems. BMC health services research, 21, 1-12.
29. SMITH, P. C. (2003). Formula funding of public services: An economic analysis. Oxford Review of Economic Policy, 19(2), 301-322.
30. SMITH, P. C. (2006). Formula funding of public services: Routledge.
31. SMITH, P. C. (2008a). Formula funding of health services: Learning from experience in some developed countries. World Health Organization.
32. SMITH, P. C. (2008b). Resource allocation and purchasing in the health sector: the English experience. Bulletin of the World Health Organization, 86, 884-888.
33. THOMAS, S., WAKERMAN, J., & HUMPHREYS, J. (2017). What does it cost to provide equity of access to high quality, comprehensive primary health care in rural Australia? A pilot study. Rural & Remote Health, 17, 1-15.
34. UĞURLUOĞLU, E., & ÖZGEN, H. (2008). Sağlık hizmetleri finansmanı ve hakkaniyet. Hacettepe Sağlık İdaresi Dergisi, 11(2), 133-160.
35. UNITED KINGDOM DEPARTMENT OF HEALTH. (2011). Resource allocation: Weighted capitation formula (Seventh Edition). Erişim tarihi: 14.04.2024, https://assets.publishing.service.gov.uk/media/5a7b81bbe5274a7202e179d4/dh_124947.pdf
36. VEGA, A., O'SHEA, S., MURRIN, C., & STAINES, A. (2010). Towards the development of a resource allocation model for primary, continuing and community care in the health services. Dublin City University.