Resource Constraints and health system funding

Introduction

Clinicians rightly feel that their place is doing clinical work and would prefer to function in a seamless environment where equipment and consumables are reliably available in a tidy environment conducive to patient care. They hope to work seamlessly in well-staffed teams with similar focus, and aspire to improve quality by identifying components needing change and then having such changes effectively implemented.

In the real world, this combination of available staff and resources able to deliver effective and continuously improving care is seldom flawlessly met, and a combination of fiscal, leadership, and implementation constraints often creates perceptions that the clinical environment is becoming progressively more challenging.

Clinicians need to have an appetite for engaging with these administrative issues, primarily as patient advocates, but also in a spirit of compromise, where it is recognized that negotiating for a better clinical environment involves recognizing that balancing resource distribution is globally challenging, but works best through engagement rather than grandstanding.

Budgets and strategic planning

Health care needs funding, and in every single system in the world there are finite budgets and by definition at least some degree of resource constraints. Within a system it is only possible to optimise efficiency and equity, and clinicians are often bewildered by seeing how money which could be spent on health in the public sector is used for what often seem like entirely profligate alternatives as determined by elected societal representatives.

Pretending this is not an issue, and demanding everything for every patient is one approach that argues for placing the clinician entirely as patient advocate, and with another ‘layer’ defining resource availability based on the financial constraints within that particular system. This seems ‘pure’ and is quite attractive for clinicians, but this shift creates an inevitable dichotomy between demanders and budget protectors, which always leaves patients and clinicians feeling they have not had best care. Best available care involves understanding resource constraints, ensuring that all clinicians are conversant with local limitations, and that such boundaries are very clear to patients.

The drawback of this is that clinicians have “FOMO” they feel that if they are rationing care by not asking for the latest and most expensive options, then their patients are missing out (and they also miss out by not getting to utilize the best options.)

A middle ground is provided by expecting practicing clinicians to have a genuine understanding of the value of the diagnostic and therapeutic options they advocate – not only efficacy and safety, but also effectiveness in the real world, and financial and opportunity costs (what else can’t be bought because of this purchase) related to measured real world benefit.

Good enough equipment

There is always a new and better tool we can use for either diagnosis or treatment; the question is whether it is actually adding patient level value proportionate to the usual extra cost. The first question should be whether the new options help, or simply add complexity. This often becomes an issue when a device reaches the plateau part of its development curve – new tweaks make little difference to core function but add to cost. Infusion pumps and ventilators are useful examples of this, where the technology is mostly now well established.

In other cases the technology jumps but remains with a core model that does much of what is required for many patients – e.g. VVI pacemaker technology is now decades old, and the only real advances are in battery longevity.  

Equipment abuse

Clinicians who are in a hurry may neglect to look after equipment, to the detriment of their future patients and hospital budgets. Assuming machines are delicate and will break, and treating them with care, has medium term benefits. The short term frustration of dealing with a blood spattered ultrasound left uncleaned by a colleague, with the probe trailing on the floor, should be translated into action to prevent recurrences. The assumption that somebody else will clean the mess is seldom tenable, and creating a culture of care and a sense of shared ‘ownership” is very worthwhile.

Consumables and why they run out (supply chain management) ¹

The ordering chain for consumables involves placement of an order which initiates a supply chain response. It is called a supply chain for a reason, and problems can (and do) arise at nearly every step:

•               Order placed with institutional supply chain
•               Order captured and linked to an order number
•               Correct quantification (deciding how much to order)
•               Determining if the item is on tender
•               Placing an order having determined that there is funding to pay for it
•               Payment processing
•               Delivery
•               Storage and distribution of the item within the institution

There are key places where problems often happen – orders are incorrectly made, quantification is inaccurate, and payments are not processed – but most of the other steps are also potential pitfalls. Chasing up the problem is often worthwhile, as expressing clinical urgency and sometimes pushing the problem up a level in the management hierarchy may well generate movement. Passivity and acceptance of the status quo is a recipe for worsening the situation.

---

1. https://bettercare.co.za/learn/public-health/text/03-10.html#unit-22-the-supply-chain-and-stock-outs ↩

Was this article helpful?

2 out Of 5 Stars

1 rating

5 Stars		0%
4 Stars		0%
3 Stars		0%
2 Stars		100%
1 Stars		0%

5 Submit

Send Feedback

How can we improve this article?

Please submit the reason for your vote so that we can improve the article.

Submit