Decisions, Decisions: Observations of Resource Allocation Under Consumer-Directed Care

Introduction: Resource trade-offs are a universal feature of decision-making in healthcare. Public funding for home care is an example of a complex resource allocation decision, requiring balance between the needs of the individual and the capacity of the welfare system to meet those needs across the population. Under consumer-directed care policies, responsibility for resource allocation decisions rests with the care recipient, but there is no existing measure of allocative efficiency resulting from these consumer-led decisions. Our research considers resource allocation decisions by home care package recipients under consumer-directed care and evaluates the consistency of consumer-directed resource allocation with medically identified recommendations. Method: Retrospective cohort analysis of twenty home care package resource allocations made by home care package recipients in South-East Queensland, compared to associated medically identified needs and discussions with a potential service provider. Findings: Resource allocation decisions in the Australian home care setting are complex, multi-faceted, and made in highly uncertain environments. There are significant differences between services and equipment recommendations made by assessment teams, service providers, and home care recipient choices. Discussion: Awareness of the decision-making process and resulting decisions provides a foundation for future research to simplify decision-making for home care package recipients without sacrificing autonomy, leading to improved resource allocation efficiency and home care program outcomes. Conclusion: Consumer-directed care is a globally popular policy position to allocate public funds related to health care needs, despite uncertainty around the impact of this policy on program outcomes. Our analysis suggests further understanding of factors influencing resource allocation decisions is needed to define appropriate supports for effective decision-making in home care resource allocation, and further research effort is required to determine efficient resource allocation to inform policy changes, irrespective of the decision-maker.