title: The balance of care approach to health and social care planning: lessons from a systematic literature review.
abstract: The strategic allocation of resources is one the most difficult tasks facing health and social care decision makers, with multiple organisations delivering complex services to heterogeneous populations. The enduring appeal of the balance of care approach, a systematic framework for exploring the potential costs and consequences of changing the mix of community and institutional services in a defined geographical area, is thus unsurprising. However, no attempt has previously been made to synthesise or appraise the methodological approaches employed and lessons to inform future applications may go unheard. This paper seeks to address those concerns by reporting the findings of a systematic literature review that identified 33 examples of the model's use spanning 40 years. The majority of studies were undertaken in the UK and explored the services needed by frail older people. There is, however, nothing in the model to restrict it to this context. The paper also details the different ways key elements of the model (information about clients, resources, the appraisal of settings, costs and outcomes) have been operationalised, and considers their strengths and weaknesses. Whilst several studies identified a potential to reduce costs via the use of less institutional care, not all applications predicted cost savings.
authors.affiliation: Personal Social Services Research Unit, University of Manchester, Manchester, UK sue.tucker@manchester.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Tucker
authors.affiliation: Personal Social Services Research Unit, University of Manchester, Manchester, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Brand
authors.affiliation: Personal Social Services Research Unit, University of Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilberforce
authors.affiliation: Personal Social Services Research Unit, University of Manchester, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Challis
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D006285:Health Planning; D006801:Humans; D040841:Resource Allocation; D012939:Social Planning; D012946:Social Welfare; D006113:United Kingdom
keywords: appropriateness of care; frameworks; health and social care; literature reviews; resource allocation; service planning