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4 - Hadsoc > deck_2256995 > Flashcards

deck_2256995 Flashcards

1
Q

Why are scarce resources a problem?

A

There are scarce resources and health expenditure is rising worldwide. Healthcare systems need to be able to allocate limited resources in spite of rising demand for services.

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2
Q

Give a demographic reason why rationing in health care systems should occur

A

There is an ageing population and the average 85 yr old costs 15 times as much as a 5-14 year old

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3
Q

Give a technology reason why rationing in health care systems should occur

A

New therapies are very expensive and expand the pool of candidates. Offer an increased survival rather than a cure

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4
Q

Why should priorities be set in healthcare?

A
  1. Scarce resources2. Demand is greater than supply3. Need to be clear who benefits from public expenditure4. Need to be clear if spending is justified
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5
Q

What are the 5 D’s of rationing in the NHS?

A

DeterrentDelayDeflectionDilutionDenial

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6
Q

Describe deterrent

A

Certain demands for healthcare are obstructede.g. prescriptions

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7
Q

Describe delay

A

Waiting lists

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8
Q

Describe deflection

A

GP’s deflect the demand from secondary care (need to see GP before specialist)

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9
Q

Describe dilution

A

Fewer testsCheaper drugs

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10
Q

Describe denial

A

A range of service are denied to patientse.g. the reversal of sterilisation, expensive treatments for rare diseases

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11
Q

What are two forms of rationing?

A

Implicit Explicit

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12
Q

Define explicit rationing

A

When institutional procedures are used to decide the systematic allocation of resources withing health care systems.

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13
Q

Give the characteristics of explicit rationing

A

Are based on defined rules of entitlementDecisions are made by the Clinical Commissioning GroupsHave to assess efficacy and equityIs also a political process

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14
Q

Give some advantages of explicit rationing

A

Transparent and accountableOpportunity for debateUses evidence based practiceThere are more opportunities for equity in decision making

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15
Q

Give some disadvantages for explicit rationing

A

Is very complexThere is heterogeneity of patients and illnessCan get patient and professional hostilityIs a threat to clinical freedomThere is evidence of patient distress

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16
Q

Define implicit rationing

A

The allocation of resources through individual clinical decisions without criteria for those decisions being explicit

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17
Q

Describe implicit rationing

A

Was the main rationing method before 1990Can lead to inequalities and discrimination. - open to abuse- decisions are made based on perceptions of social deservingness

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18
Q

What are the levels of rationing?

A
  • amount of allocation to NHS compared to other govt. priorities- amount to allocate across sectors- amount to allocate to specific interventions within sectors- amount to allocate to different patient within the same group- amount to invest in an individual patient once an intervention has been initiated
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19
Q

What is NICE?

A

The National Institute for Health Care and Clinical Excellence

20
Q

Why was NICE set up?

A

To enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources

21
Q

What does NICE do?

A

Provides guidance on whether treatments can be recommended for use in the NHS in Wales and England. Appraises new drugs and devices in order to assess:- clinical benefit- costs- local use

22
Q

What happens when NICE issues national guidance?

A

It replaces local recommendations and promotes equal access for patients all over the country– NHS organisations must fund treatments sometime with adverse effects for other priorities

23
Q

What happens when expensive treatments are not approved?

A

Patients are effectively denied access to those treatments

24
Q

Describe Tariffs

A

Payment occurs by results

25
Q

Who defines tariffs?

A

Healthcare Resource Groups (HRG)They reflect an average cost for an individual patient spell.

26
Q

How do tariffs work?

A

When a patient is in hospital, the diagnosis and treatmetns are recorder. The patient is assigned to a HRG and this determines which tariff is paid. e.g caesarean birth has a higher tariff than a normal birth

27
Q

Why are tariffs in place?

A

They are an incentive to become more efficient over time.Efficient trusts = make a profitInefficient trusts = can lose money e.g. after avoidable complications

28
Q

Define scarcity

A

Need outstrips resources. Prioritisation is inevitable.

29
Q

Defince efficiency

A

Getting the most out of limited resources.

30
Q

Define equity

A

The extent to which distribution of resources is fair.

31
Q

Define effectiveness

A

The extent to which an intervention produces desired outcomes.

32
Q

Define utility

A

The value an individual places on a health state.

33
Q

Define opportunity cost

A

Once a resource has been used in a particular way, you cannot use it for something else. The opportunity cost is the thing yo didn’t buy.

34
Q

What are the ways in which to compare costs and benefits?

A
  1. Cost minimisation analysis2. Cost effectiveness analysis3. Cost benefit analysis4. Cost utility analysis
35
Q

Describe cost minimisation analysis

A

The outcomes are assumed to be equivalent. - often is not relevant, as outcomes are rarely equivalent

36
Q

Describe cost effectiveness analysis

A

Used to compare drugs or interventions which have a common health outcome. E.g. blood pressure in terms of cost per reduction of 5mm/Hg– is it worth the cost??

37
Q

Describe cost benefit analysis

A

All inputs and outputs are valued in monetary terms– how much would you pay to have your hip replaced?

38
Q

Describe cost utility analysis

A

Focuses on the quality of health outcomes that are produced or foregone. e.g. QALY

39
Q

What is a QALY?

A

Quality Adjusted Life YearWay of measuring quantity and quality of life over a broad range of illnesses.

40
Q

What is 1 QALY equivalent to?

A

One year of perfect health. Which is also the same as ten years with a quality of 10%

41
Q

How is a QALY calculated?

A

Using a generic HR-QoL instrument e.g. EQ-5D

42
Q

How are QALYs used?

A

NICE assess the cost-effectiveness be integrating the QALY with the price of the treatments using an incremental cost-effectiveness ratio. Gives rise to a Cost per QALY figure.

43
Q

What is the Cost per QALY that is normally approved?

A

Less than £20K per QALY technology

44
Q

What needs to be taken into account when a Cost per QALY is between £20K and £30K?

A
  • degree of uncertainty- in the change in HRQoL is adequately captured in the QALY- if the innovation adds demonstrable and distinctive benefits not captured in the QALY
45
Q

What happens when the Cost per QALY is greater than £30K?

A

There needs to be a very strong case for the technology

46
Q

What are some criticisms of QALYs?

A
  • Don’t distribute resources according to need- There are technical problems with their calculations- Don’t embrace all dimensions of benefit (studies don’t represent he whole population)- There is controversy about the values that they embody

4 - Hadsoc (9 decks)

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