From a population perspective, the first stage in optimising value is the resource allocation process. Allocative value is optimised when it is not possible to switch resources from one budget to another and get more health for the population as a whole. As emphasised in a previous article, resources are traditionally allocated to institutions, to health centres and hospitals for example, but increasingly resource allocation to different subgroups of the population is coming up the agenda, driven in no small part by the Commissioning for Value Packs of NHS RightCare.1 Allocating resource to programmes allows a much clearer understanding of what happens when resources are switched from one programme to another, using the method called marginal analysis the origin of which is entertainingly described in the free RAND book called How much is enough.2
Furthermore, allocating resources to programmes such as the programme for people with visual problems, or the programme for people with mental health problems engages the clinicians involved in thinking hard about choices, as they decide how much to allocate to the various subgroups within that programme. Within the eyes and vision programme for a population, for example, there are six principal subgroups set out below:
- People with glaucoma
- People with age-related macular degeneration
- People with cataract
- People with diabetic retinopathy
- People with low vision or blindness
- Children with eye problems
Each of these six subgroups needs a system of care designed using the principles described in the preceding article but how is value to be optimised within each system?
- Value base payement
- Seeing the right people and providing best current knowledge to everyone in need
- Optimising the distribution of resources along the care pathway
- Ensuring the introduction of high value innovations
- Moving to hybrid organisation.
Journal of the Royal Society of Medicine