HaDSoc 8.1 Resource allocation

Question 1

Why do we need to set priorities in healthcare?

Answer 1

Demand outweighs supply

We can’t fund everything we want to

Question 2

Why is NHS spending increasing over time?

Why are demands increasing?

Answer 2

• Aging population (And as you get older the chances of you having chronic conditions increases)
• increasing incidence and prevelance of cancer

Question 3

What are the 2 forms of rationing?

Which is used currently?

Answer 3

• Explicit rationing (currently used)

- Implicit rationing

Question 4

Explain what is meant by implicit rationing?

Answer 4

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.

Question 5

What are the critiques of implicit rationing?

Answer 5

• 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

Question 6

What reason do some doctors have for still seeing merit in the use of implicit rationing?

Answer 6

-all patients are individual and their circumstances are unique.

using this method of rationing takes that into account and allows more flexibility.

Question 7

Explain what is meant by explicit rationing.

Answer 7

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.

Question 8

What are the advantages of explicit reasoning?

Answer 8

• transparency and accountability
• more evidence based
• more oppertunity for debate
• more likely to recieve equitable care.

Question 9

What are some disadvantages of explicit reasoning?

Answer 9

• doesn’t necessarily account for the individual patient
• Complex
• can lead to hostility between the patient and practitioner
• restricts clinical freedom of the practitioner

Question 10

What is the role of NICE in resource allocation?

Answer 10

• 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.

Question 11

Why is NICE’s role in relation to expensive treatments considered controversial?

Answer 11

• 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)

Question 12

What does utility mean with regards to health economics?

Answer 12

-The value an individual places on a particular health state. (Is a certain outcome valued by the patient)

Question 13

What does effectiveness mean with regards to health economics?

Answer 13

-is the desired outcome met by an intervention?

Question 14

What is meant by oppertunity cost?

Answer 14

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.

Question 15

What are the 2 different forms of efficiency?

Answer 15

• technical efficiency

- allocative efficiency

Question 16

What is meant by technical efficiency?

Answer 16

You’ve chosen what you want to do, what is the most efficient way of achieving this?

Question 17

What is meant by allocative efficiency?

Answer 17

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)

Question 18

How do you measure costs of health?

Answer 18

• costs in healthcare services
• costs of patients time
• costs of care giving
• economic costs associated with employer, society etc.

Question 19

How do you measure benefits of health?

Answer 19

• 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)

Question 20

What are the ways of comparing costs and benefits?

Answer 20

• cost minimisation analysis
• cost effectiveness analysis
• cost benefit analysis
• cost utility analysis

Question 21

Explain what is meant by cost minimisation analysis?

Answer 21

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.

Question 22

Explain what is meant by cost effectiveness analysis?

Answer 22

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.

Question 23

Explain what is meant by cost benefit analysis?

Answer 23

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.

Question 24

Explain what is meant by cost utility analysis?

Answer 24

Focus’ on the quality of health outcomes produced (or foregone)

Often done by the use of QALYs

Question 25

What is 1 QALY equal to?

Answer 25

- 1 year of perfect health | - 2 years of 0.5 perfect health (etc)

Question 26

What is considered when calculating QALYs?

Answer 26

- Quality of life | - Quantity of life

Question 27

How do you measure quality of life?

Answer 27

Through patient questionnaires, normally EQ-5D. | looks at different aspects of life and the patients current experience of that.

Question 28

What are some alternatives to QALYs?

Answer 28

- Health year equivalents (HYE) - Saved-young life equivalents (SAVEs) - Disability adjusted life years (DALYs)

Question 29

What is a 'cost per QALY' figure?

Answer 29

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.

Question 30

With regards to QALYs, what 'cost per QALY' figures are deemed acceptable?

Answer 30

GENERALLY <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.

Question 31

What are some criticisms of QALYs?

Answer 31

- controversy of quality vs quantity of life - distribution done according to cost instead of according to need - some technical problems with calculations - do not take into account carers or family - May not look at all dimensions of benefit RTC evidence not perfect (atypical patient, sample sizes, length to follow up (eg may not have the same quality of life over time).