| Summary: | Thesis (Ph.D.)--Memorial University of Newfoundland, 2007. Medicine Includes bibliographical references (leaves 431-464) There is increased focus, both in Canada and internationally, on the processes by which health care resources are allocated. This study examines a set of resource allocation decisions to determine how these decisions are currently being made and identify the specific concerns decision makers have about resource allocation in these areas. Specifically, the project examines how decisions involving endovascular coiling, MRIs, and powered upper limb prostheses are made in three Canadian provinces: Alberta, Newfoundland, and Saskatchewan. The overall aims of the project are: 1) to identify how these decisions are currently made, 2) to compare how these decisions are made in the different service areas and in the different provinces, and 3) to recommend ways to improve current allocation processes. -- With its focus on complex allocation processes, the project adopts a case study approach. The cases were developed using 43 key informant interviews and reviews of existing materials. The study found that many of the reforms proposed in the academic literature are often difficult to apply in real world situations, due to the multiple levels of decision makers, the transferability of decision making authority across decision makers and institutional history. -- Given that the processes for allocating resources are often developed through and in response to the unique history and culture of the institutions in question, it is also difficult to develop decision aids that are applicable over a wide range of sites. Maintaining established and familiar processes, even those not consistent with the types of decision aids recommended in the academic literature, may be the most efficient way of allocating resources for many organizations. The main implication of these conclusions is that improving the processes for allocating resources is likely going to require more institutionally-specific and area-of-care-specific reforms than researchers in this area have previously proposed.
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