Decision-making process evolution

This chapter seeks to provide some reflections on the behaviour of health expenditure and the evolution of public health financing, with particular attention to spending on pharmaceuticals. The first part attempts to lay the foundations for a series of considerations on the effects of policies aimed at restraining public health expenditure, in particular drag expenditure. In the second part we offer the reader some reflections on what could constitute an alternative framework which would help to rationalize decision-making processes on pharmaceutical financing and spending. 

The most complex driving forces in the evolution of healthcare delivery are physicians and patients resistance and readiness to accept a "different" way of practicing medicine. On one side the physician, as a patient advocate, is eager to implement various aspects of eHealth however, at the same time, they are reluctant to change beliefs that online services may depersonalize the patient-physician relationship. This coupled with the absence of information usually obtained during clinical evaluation deprives the physician of some important decision-making inputs used in the diagnostic process. There are concerns that if a patient chooses to be consulted by the quickest available physician (online), this will undermine the importance of patient history and will reduce the quality of care. 

Parallel synthesis has become an increasingly important tool for the optimization of medicinal chemistry leads. We have established a centralized parallel synthesis/purification team that collaborates with medicinal chemistry program groups for this purpose. The goal is to quickly provide substantial SAR to these teams in order to enable rapid decision making and iterative exploration of interesting chemotypes. Lean manufacturing concepts have been employed to optimize our processes and increase efficiency. We will describe the evolution of our process and lessons learned over the past two years. 

It is obvious that such a ruthless all-or-none decision could neither be a consequence of random production nor result from interactions as they are responsible for chemical equilibrium, which always settles on finite concentration ratios. It is indeed the peculiar mechanism of the reproduction process far from equilibrium that accounts for the fact of survival, and this mechanism is even active when the competitors are degenerate in their selective values, that is, if they are neutral competitors. In this limiting case, considered to be very important for the evolution of species, Darwin s principle indeed reduces to the mere tautology survival of the survivor. Nevertheless, there are, even here, systematic quantitative regularities in the way that macroscopic populations of wild types rise and fall in a deterministic manner (as far as the process, not the particular copy choice, is concerned), which make it anything but a trivial correlation. This case of neutral selection has been called non-Darwinian. It should be emphasized, however, that Darwin was well aware of this possibility and described it verbally in a quite adequate way. The precise formulation of a theory of neutral selection, which then allows us to draw quantitative conclusions on the evolution of species is an achievement of the second half of this century. Kimura [2] has pioneered this new branch of population genetics. 

In the previous section we presented a set of models of demand/forecast evolution that are fairly common in the inventory management literature. Clearly, this collection of models was not intended to be exhaustive. Nevertheless, these models share an important advantage They are sufficiently descriptive of demand processes in a large variety of settings, and at the same time, they are simple enough to be embedded into inventory decision models without making them virtually intractable. Indeed, the purpose of this section is to explain some of the complexities associated with the control of inventory for products that face the above types of demand processes, and to direct the reader to the relevant literature. 

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