Knowledge Strategies: Propositions From Two Contrasting Industries

Allocation and Distribution of Scarce Resources

Age, “Life-Cycles,” and the Allocation of Scarce Medical Resources

The view of patents as non-rivalrous property is fundamentally flawed in a key respect that has been largely overlooked in the legal literature. Past scholarship has focused on downstream rivalry regarding the use of patented ideas, while neglecting upstream rivalry regarding the inputs to those ideas in many modern research settings, i.e., the efforts of inventors and the substantial research resources that support them. By reexamining the impacts of patents on allocations of scarce resources, this Article helps to clarify two important roles of patents in modern, large-budget innovation: First, patent-influenced rewards help to attract scarce resources to innovation projects that would otherwise be devoted to alternative ends. Second, patent-influenced rewards provide prioritizing information to persons allocating scarce resources, establishing a basis to compare the relative value of commitments of resources among innovation projects. As innovation projects assume ever larger and more central functions in the United States economy, patents in the areas addressed by this Article will only increase in importance. The function of patents in influencing the allocation of resources to invention production has received remarkably little attention in law review analyses to date. This Article aims to rectify this imbalance and highlight the important functions that patents play in producing innovations valued by the public.

It is pointed out that matching potentially strong developers with appropriate knowledge-based system (KBS) development projects can optimize an organization's allocation of scarce human and financial resources. In a broader sense, it can contribute to supporting an organization's effort to develop the creative computer systems necessary for competitive positioning. To test this hypothesis, the authors report the results of a study of 91 developers new to KBS technology. This group served as a test bed to explore an answer to the question 'can we learn what kind of developer creates a successful (i.e., innovative and useful) knowledge-based system?' In other words, it there a 'successful KBS developer' profile? The results provide tentative answers that need to be reconsidered with more rigorous further study. >

Studying the most ethical way to allocate scarce medical resources has been of interest within the last year, due to shortages associated with the COVID-19 pandemic. This study aimed to establish differences between what healthcare providers (HCP) and laypeople consider to be the most ethical way to prioritise the distribution of scarce resources. Healthcare providers ( n = 100) and laypeople ( n = 102) were asked to rank ethical principles from most to least ethical for the allocation of ICU beds in a COVID-19 outbreak, COVID-19 vaccinations and organ transplantation, and the rankings from each scenario across the two groups were compared. Results indicated that HCPs preferred utilitarian principles informed by medical knowledge, such as ‘prognosis’, whereas laypeople preferred less situation-specific and prioritarian principles, such as ‘sickest first’, replicating pre-pandemic findings. Laypeople showed increased in-group agreement when ranking principles, potentially due to the collective experience of the pandemic. Demographic variables such as older age, identifying as Black, Asian or minority ethnic and greater experience with COVID-19, were also associated with a preference for ‘prognosis’.

Tragic Allocation Challenges in the COVID-19 Era

Climate change has moved rapidly from the fringes of scientific research to become a topic that is central to debates among scholars from a wide variety of disciplines. It is now a front-burner issue for governments, businesses, civil-society organizations and publics. As the science of climate change has improved, and as its impacts start to be felt around the world, it has become clearer that this issue is about much more than changes to the natural environment. It is also about politics and the distribution of scarce resources among and within national communities. It is about harsh impacts being felt by some more than others, not least by those individuals and communities least responsible for causing the problem. It is about the disproportionate responsibility of the world’s affluent people and nations. In short, climate change is a matter of equity, fairness and social and distributive justice.

Health economics deals with issues about the use of scarce resources in healthcare. An important branch of health economics concerns economic evaluations, which consist of a comparison of the costs and effects of 2 or more treatments. The role and importance of economic evaluations in oral care are increasing but are not yet as evident as in other areas of healthcare (such as pharmacy). An economic evaluation provides a broad picture of the costs and health benefits of a particular diagnostic or treatment strategy, resulting in a cost-effectiveness ratio (expressed, for example, as costs per quality-adjusted life year gained). The results are intended for use in policy-making, such as decisions about in- or exclusion from the basic benefits package. To date, only a limited number of economic evaluations of oral care have been carried out, mainly focused on caries. It is important to be able to demonstrate that the treatment provided in oral care is cost-effective. Oral care may put itself in a vulnerable position in the distribution of scarce resources when the costeffectiveness of its treatments is uncertain.

AS THE HEALTH CARE REFORM DEBATE HAS BECOME more fractious and politicized, the need for clear, productive, and patient-centered input from physicians has increased. The cumulative actions of individual physicians can have a substantial effect on meaningful and lasting reform. For the medical profession to assume a leadership role, individual physicians will need to (1) acknowledge the inequitable and dysfunctional nature of the current health care system and the role of physicians in perpetuating that system, (2) examine his or her professional responsibilities to the public, and (3) take action with specific concrete behaviors that will facilitate and guide efforts to improve the health care system. Physicians have learned to work within a dysfunctional system—committing extra hours to arguing with insurers to obtain a medication for one patient, a computed tomographic scan for another, and a surgical procedure for a third. The annual cost of challenging third-party payers has been estimated at $68 000 per physician. The system has become so unmanageable that some physicians are willing to use deceit to secure insurance coverage for a medical procedure. These burdensome practices and costs, however, have not been effectively challenged by physicians—even during this time of reform. For many physicians, it may simply be a matter of having limited time or a distaste for politics. Others may be resigned to working within a system that is familiar, despite its dysfunction. Whatever the reason, in remaining silent, physicians have perpetuated a system in which patient access to medical care is too often reliant on the physician’s willingness to participate in, and at times game, a highly inequitable system. The American College of Physicians’ charter addresses the professional obligations of a physician, encouraging physicians to work at the societal level to improve access to care, reduce discrimination, manage conflict of interest, control medical expenditures, and facilitate a just distribution of scarce resources. In accordance with these principles, there are immediate and concrete steps physicians can take both at the bedside and in the community to help reshape the health care system and fulfill their moral and professional duties to the public. Work Daily to Provide High-Quality Care Physicians must commit to improving quality in their daily practice. Nearly half of patients do not receive evidencebased medical care, chronic illness is often poorly controlled, and many patients do not receive clinically needed preventive services. Physicians must respond by adopting new approaches to measuring and improving the quality of care they are providing. Physicians and group practices can receive incentive payments for participation in Medicare’s physician quality reporting initiative. Additionally, professional societies and insurers often have mechanisms for collecting and reporting quality data. These data can be used by physicians to improve performance and patient care.

Previous studies on the allocation of scarce medical resources have shown that certain patient variables (e.g. sex, age, number of dependants) significantly affect lay participants' rank ordering of them for costly treatment. This study replicates the methodology of these studies (Furnham, Meader, & McClelland, 1999, Furnham, Simmons, & McClelland, 2000) but using allocation to social housing as the dependent variable. One hundred and sixty-three adults rank ordered sixteen people to be allocated a flat from a housing list. The results indicated that whereas gender made no difference in the decision, nonsmokers were favored over smokers, the mentally healthy over the mentally ill; and those with average intelligence over those with high intelligence. These results are comparable to those from studies looking at the allocation of scarce medical resources.

The advent of craniofacial surgery and neonatal intensive care has made it possible for children with serious craniofacial deformities to live and possibly to experience effective habilitation. These therapeutic innovations also raise important social and ethical issues that are rarely examined. This paper reviews the dilemmas that relate to the gatekeeper role for physicians, the impact of prenatal diagnosis, and the allocation of scarce fiscal and health resources to craniofacial care. The high degree of cost, the intense investment of medical resources, and the uncertain outcomes in the care of children with major craniofacial deformities, must be considered in the distribution of resources within a health system. The rationing of health resources is discussed as a future determinant of how care for major craniofacial deformities may be delivered in the United States.

Minnesota Hospitals’ Plans for Implementing Statewide Guidance on Allocation of Scarce Critical Care Resources During the COVID-19 Pandemic

The industrial working-time regime is dissolving—not dramatically, but rather as a trend. A new trend is that those in dynamic sectors and in a good labor market position work long hours: Demanding knowledge work appears to require the marginalization of private life. This study investigates the family situation of knowledge workers, the concentration of knowledge workers into family, working time, and use of time in different family types. The analysis is based on the Finnish Use of Time data (1999-2000) using family(spouse)-level data. Compared with other categories of employment, the results suggest only minor quantitative differences between knowledge worker families in working time and use of time. However, the results show that qualitative experience of time varied across families. Knowledge work families especially experienced feelings of hurriedness and time famine.

Catholic Social Teaching and the Allocation of Scarce Resources John Langan S.J. (bio) I shall approach the issue of justice in the allocation of scarce resources from the viewpoint of Catholic social teaching, as developed over the last century. This teaching is found primarily in the social encyclicals issued by popes from Leo XIII (1878–1903) to John Paul II (1978- ), but also in the pastoral letters of the various bishops’ conferences, especially in the United States and in Latin America. These documents, which enjoy a high standing in Catholic teaching but which are not taken as binding in all their particulars, form part of a tradition of moral and social theorizing that a contemporary American would regard as “communitarian.” On social questions, this tradition also has shown itself to be historicist in that it is capable of modifying itself in significant ways in response to changing political and economic situations. It normally approaches issues from a universalist perspective, though it has shifted from a preoccupation with the concerns of the industrial societies of Europe to an advocacy of much of the reform agenda of the Third World. Rooted in classical and biblical sources and modified in the course of the last [End Page 401] century to include a principled acceptance of religious freedom, of human rights, and of democratic political institutions, the Catholic social tradition proposes a number of ideas that can serve as the basis for significant criticism of currently dominant liberal modes of organizing and interpreting advanced industrial societies. These ideas do not form a countertheory to liberalism so much as they indicate ways in which a religious organization that includes both hierarchical and egalitarian elements in its structure and that has both moral commitments and practical responsibilities with regard to health care can draw on its intellectual resources to develop alternative strategies for the reform of health care. I shall survey six ideas that figure prominently in Catholic social teaching and that are relevant to the allocation of scare resources in American health care. Space constraints require that I present them in a very condensed fashion, without tracing the complex development they have undergone in the internal Catholic debate or subjecting them to much criticism. First, Catholic social teaching, especially the great encyclical of John XXIII, Pacem In Terris (PT 1963), affirms the full range of human rights recognized in such modern documents as the Universal Declaration of Human Rights (1949). In addition to the civil and political rights enumerated in the Bill of Rights added to the original U.S. Constitution (1791), the Universal Declaration includes rights “to life, to bodily integrity, and to the means which are suitable for the proper development of life; these are primarily food, clothing, shelter, rest, medical care, and finally the necessary social services” (PT 11). Catholic social teaching has not committed itself to one particular way of institutionalizing these rights, but it effectively endorses the comprehensive West European welfare states that the Christian Democratic political parties helped to construct in the period after 1945. Second, Catholic social teaching has accorded a central organizing role to the notion of the common good, the realization of which “is the whole reason for the existence of civil authorities” (PT 54). The common good, however, is not to be understood as identical with the interest or the power of the state; rather, it “embraces the sum total of those conditions of social living whereby men are enabled to achieve their own integral perfection more fully and more easily” (PT 58; quoting Mater et Magistra). John XXIII is particularly anxious to affirm that the common good cannot be construed so as to exclude some groups or to violate the rights of individuals and that it must include both physical and spiritual goods (PT 55–61). The notion of the common good has both an inherent attractiveness and a vagueness that cries out for specification and clarification. But in the contemporary situation it serves to remind us that “individual citizens and intermediate groups are obliged to make their specific contributions to the common welfare” (PT 53). Third, while an insistence on the primacy of the common good and on the [End Page 402...

The coronavirus disease 2019 (COVID-19) pandemic is resulting in ethical decisions regarding resource allocation. Prioritisation reflects established practices that regulate the distribution of finite resources when demand exceeds supply. However, discrimination based on sex, race or age has no role in prioritisation unless clearly justified. The risk posed by COVID-19 is higher for elderly people than for younger people, so older adults should be prioritised in preventive measures. In the case of people who already have COVID-19, healthcare professionals might prioritise those most likely to survive. Making decisions based on chronological age alone is not justified; in addition to age, other aspects that determine theoretical life expectancy must be taken into account. Individualised correct prioritisation in the allocation of scarce resources is essential to good clinical practice.