An alternative approach to resource allocation: weighted capacity to benefit plus MESH infrastructure.

This article outlines an approach to resource allocation in healthcare that embraces the concepts of 'capacity to benefit' and management economic social and human (MESH) infrastructure. Health service jurisdictions differ in terms of their capacities to produce benefits for the people they serve. This is for three reasons: (i) some populations already have relatively good health, so the capacity to benefit further is limited compared with others; (ii) even where the health levels of two populations are similar, one population's health problems can be more amenable to health service interventions, i.e. its capacity to benefit from healthcare interventions is greater; and (iii) even where both the health levels and the health problems are similar, one health service may be better placed or better equipped to deliver benefit to its population than the other. In the case of (iii), the capacity to benefit is inhibited because it lacks the necessary MESH infrastructure to deliver health benefits to its population. The approach to resource allocation outlined in this article differs from the more conventional approaches. While resource allocation working party (RAWP)-type formulae concentrate on allocating resources primarily according to the size of the problem (often called heath need and measured in terms of some assessment of the amount of sickness in a population), the starting point with weighted 'capacity to benefit' plus MESH is to ask what good or benefit is sought in allocating resources. In so far as there are variations in the abilities of different authorities by way of MESH, this can result in uneven implementation of health service interventions and consequent inequities and inefficiencies for the relevant populations. There is a need to address this problem of variation through providing support to those jurisdictions that are deficient in these abilities. The building of MESH infrastructure is to be seen as a major plank in any equity strategy, as it may well be the neediest jurisdictions that are most often lacking in MESH. The lack of MESH in these communities will then exacerbate inequities in service delivery.