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Resource Allocation and Health Service Planning

Learning Outcomes for general perusal

LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

LO2 - Discuss the drivers and process of service development.

LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

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LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Resource allocation

  1. What do Health and Social Care (HSC) system resources include?
  2. What set the overall boundaries or constraints for HSC organisation and delivery?
  3. In practice what does resource allocation refer to?

  1. available funding, workforce and capital assets. 

  2. Levels of funding

  3. the task of prioritising HSC funding

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LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Rationing and Rational Planning

  1. What is rationing a consequence of?
    1. What can this mean for the patient?
  2. Within a fixed, scarce budget, all decisions to fund results in what?

  1. priority setting
    1. Patient may be denied access to a treatment or service, experience a delay or poor quality services which impact on the clinical outcome.
  2. opportunity costs (Potential rationing consequence in the HSC system.)

4

LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Health Policy and Service Development

  1. What could health policy be summarised as?
  2. What does service development involve?
    1. What is this driven by?

  1. a formal adopted, or proposed, statement of goals, values, principles, and broad parameters for a societal or health system response to an identified problem or issue. 
  2. National standards, targets, agencies and regulatory approaches. ('must-dos’).  Evolving clinical practice, leading to cost pressures and service developments in provider organisation.
    1. Patient-driven (choice, voice & competition)

5

LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Criteria to consider if service development is a priority

List the criteria

  • Imperative
  • Value for money
  • Risk avoidance
  • Access

6

LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Criteria to consider if service development is a priority

List the criteria, and expand upon each

  • Imperative
    • Is the development/cost pressure an imperative? (e.g. NICE guidance priority; a National Service Framework requirement; NHS target; local priority)
  • Value for money
    • Does the proposed development have a robust evidence base, and will it be cost-effective in terms of net health gain, or avoid investment (or secure savings) in other areas?
    • Are there alternative options for providing the service?
    • Do we need to take account of prevalence pool growth in future years?
  • Risk avoidance
    • Are there major risks associated with failing to support the proposed development/cost pressure (e.g. morbidity, mortality, litigation, political & public pressure, destabilising the service, making the service unsustainable)?
  • Access
    • Will the proposed development improve patient access to services, or reduce health inequalities? 

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LO1 - Discuss broad approaches to and real politics for funding and prioritising services.

Funding mechanisms

What are the funding mechanisms?

  • Taxation (Beveridge);
  • Social insurance contributions (Bismarck);
  • Voluntary insurance premium;
  • Out-of-pocket payments or user charges.

8

LO2 - Discuss the drivers and process of service development.

Funding - Drivers and Pressures

Outline the drivers and pressures

  • Social trends - valuation of health and health and social care provision;
  • Demographic trends and patterns of morbidity;
  • Rising costs - health technological innovations and developments;
  • Higher expectations - range and quality of care provided; (demand management)
  • Inequitable access to care
  • Extent to which resources are used efficiently.

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LO2 - Discuss the drivers and process of service development.

Funding - Drivers and Pressures

  1. What is cost effective analysis?
    1. What does a cost-utility analysis require?
  2. What is cost benefit analysis?
    1. What do comparisons require?

  1. Compares monetary cost per natural unit of a given consequence.  Comparisons are based on dominance, relevant ratios, and incremental cost-effective ratios. 
    1. a common utility unit.
  2. Requires an explicit monetary valuation of identified consequences. A base line or "status quo" option is the usual comparator. 
    1. the estimate of net benefits should exceed net costs. 

10

LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

Measurement of Health Gain

  1. What are QALYs?
  2. What is one QALY equivalent to?
  3. What my Quality of Life be weighted using?
  4. What system to NICE recommend to use as an instrument to measure HRQL in adults?
  5. What must economic evaluations also consider?

  1. Quality-adjusted life years - “common currency” to measure and compare the efficiency of different interventions. An index of observed survival weighted by estimated health state utility.
  2. to one year in full health.
  3. generic measures of health-related quality of life (HRQL) based on societal values or condition-specific based on patient group preferences. Different systems may produce different utility values, and direct comparisons may not be possible.
  4. the generic EQ-5D instrument: mobility; ability to self-care; ability to undertake usual activities; pain and discomfort; and anxiety and depression.
  5. must also consider time preference and discounting for expected health gains.

11

LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

Measurement of Health Gain

NICE recommend the generic EQ-5D instrument to measure HRQL in adults, list what is measured in this.

  • mobility
  • ability to self-care
  • ability to undertake usual activities
  • pain and discomfort
  • anxiety and depression.

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LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

Previous decision principle

  1. What is the 'rule of rescue' principle?
    1. What does the needs of such an individual not outweight?
    2. What was NOT recommended as a result?

  1. Monetary cost is not important in the context of any attempt to help an identifiable person whose life is in danger.
    1. The needs of such an individual should not outweigh the needs of anonymous present and future NHS patients.
    2. Therefore, use of differential QALY weights was previously not recommended. 

13

LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

Previous decision principle

Supplementary NICE advice was issued in 2009 (Price of life) for appraisals of end of life treatments that are “life-extending”. 

  1. What does this advice state?

 

  1. Where the estimated ICER is excess of £30,000 - then the assumption that the extended survival period is experienced at full quality of life (anticipated for a healthy individual of the same age) must be considered.

14

LO3 - Modus operandi of National Institute of Clinical Excellence (NICE)

Previous decision principle

Supplementary NICE advice was issued in 2009 (Price of life) for appraisals of end of life treatments that are “life-extending”. 

What is ICER?