title: Healthcare resource allocation decisions affecting uninsured services.
abstract: Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies. Organizational values of access to care and stewardship most frequently affected resource allocation and policy decisions, while economic and political pressures affect the relative prioritization of values. Research limitations/implications Small sample size, the potential for social desirability or recall bias, and the exclusion of provider, member or community perspectives beyond those represented among participating board members. Practical implications Program directors or researchers can use this study to assess the extent to which resource allocation and policy decisions align with organizational values and mission statements. Social implications The description of how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions. Originality/value This study addresses a gap in literature regarding how CAPs actually make resource allocation decisions that affect access to healthcare services.
authors.affiliation: Division of Geriatrics, University of California , San Francisco, California, USA.|San Francisco VA Medical Center, San Francisco, California, USA.
authors.forename: Krista Lyn
authors.initials: KL
authors.lastname: Harrison
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Berman Institute of Bioethics, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Holly A
authors.initials: HA
authors.lastname: Taylor
mesh_terms: D003657:Decision Making; D006291:Health Policy; D006296:Health Services; D007407:Interviews as Topic; D017057:Medically Uninsured; D015279:Organizational Culture; D036301:Qualitative Research; D040841:Resource Allocation
keywords: Decision making; Healthcare; Organizational culture; Policy; Uninsured; Values