Session 8 Flashcards
Why are demands on the NHS rising?
Ageing population
People with severe illnesses are surviving
Costs of new technology - often increase survival, but not cure
Why do we need to set priorities in Heathcare?
Because resources are scarce
Resources could be used in other ways
So it is clear & explicit who benefits from public expenditure
Need to assess whether it is worth the money
What are the 5Ds on rationing in the NHS?
Deterrent - demands for healthcare are obstructive
Delay - waiting lists
Deflection - GPs deflect demand from secondary care (gatekeepers)
Dilution - generic brand drugs
Denial - range of services are denied to patients eg infertility treatment.
What are the 2 main forms of rationing in the NHS?
Explicit - based on defined rules of entitlement
Implicit - care is limited, but neither the decisions or the basis of those decisions are clearly expressed (pre 90s)
What are the issues with implicit rationing?
Can lead to inequity & discrimination
Doctors had to decide allocation of resources, perceptive decisions
Open to abuse
What is explicit rationing?
Care is limited and the decisions were explicit as the reasoning behind those decisions - think NICE guidelines and government Technical/political processes Transparent & accountable Opportunity for debate Uses evidence based practice More opportunity for equity
What are the disadvantages of explicit rationing?
Very complex Heterogeneity of patients/illnesses Patient and professional hostility Threat to clinical freedom Evidence of patient distress
What are the levels of rationing in the NHS?
1) how much does the NHS get compared to other government priorities
2) how much do you allocate across sectors in the NHS
3) how much do you allocate to specific interventions within sectors
4) how do you allocate interventions between different patients in the same group
5) how much should be invested in each patient once an intervention has been initiated
What is the role of NICE?
Give national guidance on if a treatment can be used in the NHS in England and Wales that is binding.
Base guidelines on the newest evidence
While a drug is being approved by NICE, the NHS can make local decisions, but once it is decided the guideline replaces local decision
What are tariffs?
When a hospital treats a patient, the diagnosis and treatment are recorded and coded. This information determines which healthcare resource groups the patient is assigned to and the tariff that is paid.
Allow efficient trusts to make a profit.
Money is lost if a never event occurs
What does the public think about rationing of services?
There is resistance to rationing
Most think that people who need the healthcare should have it regardless of cost
Tend to value heroic interventions and favour certain groups
Discriminate against those who have partial responsibility for their illness.
