Flashcards in HaDSoc 8.1 Resource allocation Deck (31):
Why do we need to set priorities in healthcare?
Demand outweighs supply
We can't fund everything we want to
Why is NHS spending increasing over time?
Why are demands increasing?
-Aging population (And as you get older the chances of you having chronic conditions increases)
-increasing incidence and prevelance of cancer
What are the 2 forms of rationing?
Which is used currently?
-Explicit rationing (currently used)
Explain what is meant by implicit rationing?
There are no rules on who gets what treatment.
Care is limited but it is left down to clinical judgement who gets what care.
There is no explicit criteria.
What are the critiques of implicit rationing?
-Can lead to discrimmination and inequities
-Can decide who gets what based on 'social deservingness (not ethical)
-Doctors often unwilling to do it
-can be abused
What reason do some doctors have for still seeing merit in the use of implicit rationing?
-all patients are individual and their circumstances are unique.
using this method of rationing takes that into account and allows more flexibility.
Explain what is meant by explicit rationing.
Care is limited but the decisions about prioritising are explicit.
Analysis and research is done to decide who gets what, and explainations can be made.
What are the advantages of explicit reasoning?
-transparency and accountability
-more evidence based
-more oppertunity for debate
-more likely to recieve equitable care.
What are some disadvantages of explicit reasoning?
-doesn't necessarily account for the individual patient
-can lead to hostility between the patient and practitioner
-restricts clinical freedom of the practitioner
What is the role of NICE in resource allocation?
-they approve treatments for use, and advise them but this doesn't mean you MUST use this treatment.
-Once guidance of a drug has been issues, all patients across the country have equal access to it.
Why is NICE's role in relation to expensive treatments considered controversial?
-If they're not approved, patients are denied access to that drug (except in very special circumstances)
-If they are approved, they must be funded despite being expensive (which can have knock on effects for other treatments)
What does utility mean with regards to health economics?
-The value an individual places on a particular health state. (Is a certain outcome valued by the patient)
What does effectiveness mean with regards to health economics?
-is the desired outcome met by an intervention?
What is meant by oppertunity cost?
Once you decide to spend money on one thing, it can no longer be spent on other things.
Measured in terms of benefits foregone.
Cost viewed as a sacrifice.
It looks at whether that treatment is good value for money compared to the alternative uses of that money.
What are the 2 different forms of efficiency?
What is meant by technical efficiency?
You've chosen what you want to do, what is the most efficient way of achieving this?
What is meant by allocative efficiency?
you chose between many different needs.
You have a resource (eg money) and you're choosing between what to use that resource on (eg hip replacement or neonatal care)
How do you measure costs of health?
-costs in healthcare services
-costs of patients time
-costs of care giving
-economic costs associated with employer, society etc.
How do you measure benefits of health?
-impact on health status
-savings of other resources (Eg by improving someones health you decrease the apoointments and drugs that person will be on)
-improved productivity (eg patient going back to work, contributing to society)
What are the ways of comparing costs and benefits?
-cost minimisation analysis
-cost effectiveness analysis
-cost benefit analysis
-cost utility analysis
Explain what is meant by cost minimisation analysis?
Assumes the outcomes are the exact same, and you look at the interventions and chose the cheapest one.
not relevant because you barely ever get identical outcomes.
Explain what is meant by cost effectiveness analysis?
Looks at interventions which have a common outcome (eg reduction in blood pressure).
It then compares the extent of the outcome against cost. (Cost per unit of outcome)
Looks at whether extra benefit is worth the extra cost.
Explain what is meant by cost benefit analysis?
Inputs and outputs pt in monetary terms.
Looks at how much a particular health state is worth.
Can be done by asking a patient 'how much would you pay to have your heart surgery' (For example)
Unreliable because people are never going to have to pay so will often say they'd pay more than they would.
Negative views around placing a value on a health state.
Explain what is meant by cost utility analysis?
Focus' on the quality of health outcomes produced (or foregone)
Often done by the use of QALYs
What is 1 QALY equal to?
-1 year of perfect health
-2 years of 0.5 perfect health (etc)
What is considered when calculating QALYs?
-Quality of life
-Quantity of life
How do you measure quality of life?
Through patient questionnaires, normally EQ-5D.
looks at different aspects of life and the patients current experience of that.
What are some alternatives to QALYs?
-Health year equivalents (HYE)
-Saved-young life equivalents (SAVEs)
-Disability adjusted life years (DALYs)
What is a 'cost per QALY' figure?
The result of combining the cost effectiveness of a treatment with the resulting QALY score.
It allows for comparisons of different treaments, their costs and benefits.
With regards to QALYs, what 'cost per QALY' figures are deemed acceptable?
<20K per QALY will normally be approved
20-30k will take into account other factors (eg if certain benefits arent captured properly in the QALY)
>30K needs an increasingly stronger care.