Health Economics

Question 1

What is scarcity, opportunity costs and efficiency in relation to health care provision

Answer 1

Scarcity - shortage of resources - funding, staff,
Opportunity costs - loss of health benefits by using resources for a different health need
Efficiency - obtaining the greatest health benefit from interventions using the available resources or obtaining a given health benefit in a way that minimises costs or resources

Cost effectiveness
- incremental cost effectiveness ratio ICER - as a service improves will cost more balanced against improvements in outcomes eg different freqencies of cervical or breast screening = difference in cost of new vs old divided by difference in outcome of new vs old
compare with cost effectiveness threshold - £20 -30 000
- what is society prepared to pay for QALY?

Question 2

Organisation of Health Systems around the world

Answer 2

Health Care is funded by taxes, social insurance contributions, private health insurance or by individuals

Different countries use different combinations - affects health care

GPs self employed - paid by number of patients/treatments

Hospitals - Payment By Results, Staff may have performancerelated pay/pay progression

= Universal Government Funded Health Care - available to nearly all citizens eg UK

= Universal Public Insurance System - social inusurance where employers an demployees contribute - if not working and not registered as unemployed may not get health care eg France

= Universal Public-Private System - private health care and provided by state if not eligible eg germany

= Universal Private Insurance - mandatory to have health insurance usually subidised by government if low income eg Switzerland

= Non universal health system - some have private insurance, some eligible for public funded health care and some people no healthcare eg US

Question 3

WHO criteria to assess stengths heathcare system

Answer 3

2 questions
= How to measure the outcome of interest - measure good heath, responsiveness and fairness of financial contribution
= How to compare what is achieved with what should be achieved - efficiency

System Building Blocks:

• Leadership and Governance,
• Health Workforce
• Finance
• Service Delivery
• Information and REsearch
• Medical products, technologies

consider coverage, access, quality and safety

and 
Assess outcomes:
- improved health 
- responsiveness
- financial risk protection
- efficiecy

Question 4

Equity in relation to health economics and health systems

Answer 4

Equity = fairness and justice - everyone should have equal opportunity for heath and access to services

• is not the same as equal distribution of services
• consider ethnicity, age, sex, loaction (eg rural/ city), language, disability

(- remember using boxes to look over a fence)

Question 5

Decisions on what should be available on NHS

Answer 5

Analysis of:
Cost Effectiveness - cases prevented, years of life saved
Cost Utility - QALYs
Cost Benefit - how willing we are to pay

QALYs- Quality Adjusted Life Years
DALYs - Disability Adjusted Life Years - measure of disease burden

Use
ICER
NICE guidance

Question 6

NICE

Answer 6

National Institute for Health and Care Excellence

Part of Department of Health

Publishes guidelines for use of new technologies, which treatments to use and for social care - considers all available evidence, costs and involves clinical teams to make decisions

Aim to standardise care and reduce postcode lottery

Regularly audit practice against NICE guidance