8. resource allocation and PROMS Flashcards
(70 cards)
priority setting defintion
describes decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care.’
Priority setting is just resource allocation,
—-> deciding who gets resources when they are scarce
rationing definition
Rationing describes the effect of those decisions on individual patients, that is, the extent to which patients receive less than the best possible treatment as a result’
priority setting and rationing together are
‘’In combination, priority setting and rationing can be understood as the processes by which services that may be of benefit to users are withheld on grounds which include cost’
why set priorities when assigning resources
• Because of scarcity of resources – demand outstrips supply.
Ageing populations
Increasing incidences of chronic disease
Pandemic, health issues like diabetes
Funding medical advances
Rise in public expectation of NHS
Dwindling budget
what is demand driven by
Demand is driven by demographics
–> significant changes in number of those with long term conditions
Illness costs money
2 forms of rationing
explicit rationing
implicit rationing
explicit rationing definition
• Based on defined rules of entitlement
- use of institutional procedures for the systematic allocation of resources within health care system
implicit rationing definitionin
Implicit rationing is the allocation of resources through individual clinical decisions without the criteria for those decisions being explicit
issues with implicit rationing
Can lead to inequities and discrimination
Open to abuse
Decisions based on perceptions of “social deservingness” and not clinical need
Doctors appear increasingly unwilling to do it
impacts of explicit rationing
Care is limited and the decisions are explicit, as is the reasoning behind those decisions
Technical processes e.g. Assessments of efficiency and equity
Political processes e.g. Lay participation
advantages of explicit rationing
- Transparent, accountable
- Opportunity for debate
- More clearly evidence based
- More opportunities for equity in decision-making
disadvantages of explicit rationing
- Very complex
- Heterogeneity of patients and illnesses
- Patient and professional hostility
- Impact on clinical freedom
- Some evidence of patient distress – when they know care is rationed
example of explicit rationing
—> score card for a treatment or intervention, score based on both clinical and social evidence
features of explicit rationing
Strength of evidence
Effectiveness
Number of people who will benefit
Costs
Patient acceptability
National requirements
Equity
Societal benefits
Treatment alternatives
‘Strength of local feeling
NICE
• Set up 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’
NICE – responsibilities
appraise significant new drugs and devices to
- ‘help make sure that effective and cost effective products are made available to patients quickly
to minimise variations in the available of treatments.’
NICE - controversial role
in relation to expensive treatments
If not approved, patients are effectively denied access to them (except for individual requests)
If approved, local NHS organisations must fund them (if clinically appropriate), sometimes with adverse consequences for other priorities
scarcity
Need outstrips resources. Prioritisation is inevitable
efficiency
Getting the most out of limited resources
equity
The extent to which distribution of resources is fair- equally accesible
effectiveness
The extent to which an intervention produces desired outcomes
utility
The value an individual places on a health state
opportunity cost
Once you have used a resource in one way, you no longer have it to use in another way
—> used to decide if something is good value for money
when is opportunity cost used
When deciding to spend resources on a new treatment, those resources cannot now be used on other treatments.
The opportunity cost of the new treatment is the value of the next best alternative use of those resources.
Cost is viewed as sacrifice rather than financial expenditure
Opportunity cost is measured in BENEFITS FOREGONE – benefits lost when choosing one approach over another
