HaDSoc Session 8 Flashcards Preview

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Flashcards in HaDSoc Session 8 Deck (54):
1

What is explicit rationing based on?

Defined rules of entitlement/institutional procedures for systematic allocation

2

What is implicit rationing based on?

Individual clinical decisions without explicit criteria

3

Why is healthcare expenditure rising worldwide?

Changing demography, technology, consumerism, increasing demand

4

What are the problems associated with implicit rationing?

Inequities, discrimination, can be abused, social deservingness

5

What are the benefits associated with implicit rationing?

More sensitive to complexity of medical decisions, needs and preferences of individual pts

6

What are the advantages of explicit rationing?

Transparent, accountable, opportunity for debate, more clearly evidence-based, mor opportunities for equity

7

What are the disadvantages of explicit rationing?

Very complex, heterogeneity of pts and illnesses no accounted for, pt and professional hostility, impact on clinical freedom, some evidence of pt distress when denied Tx

8

What are the 5 levels of allocation?

Allocation to NHS vs other sectors; across specialities; specific interventions; interventions between pts of same group; investment for each initiated intervention

9

What is the purpose of NICE?

Evidence of clinical cost effectiveness integrated to inform a national judgement on the value of a Tx relative to alternative use of resources

10

Why does NICE guidance replace local recommendations?

Provide equal access across the country so effective and cost-effective interventions are made available quickly

11

What happens if an intervention receives NICE approval?

Local NHS organisations must fund if clinically appropriate, thus removing funding from elsewhere

12

What happens if NICE does not approve an intervention?

Pts are effectively denied access except for individual requests

13

What is the purpose of health economics?

Provide info to assist allocation of scarce resources to maximise social benefits

14

What is the need for economic assessment?

Bring reality of fixed NHS resources to public attention, expose opportunity costs, enable consistency in investment, direct innovation, help make principles of allocation explicit, help Dr's to understand/contribute to evidence

15

What are the basic concepts in health economics?

Scarcity, efficiency, equity, effectiveness, utility, opportunity cost

16

What are the 5 levels of allocation?

Allocation to NHS vs other sectors; across specialities; specific interventions; interventions between pts of same group; investment for each initiated intervention

17

What is the purpose of NICE?

Evidence of clinical cost effectiveness integrated to inform a national judgement on the value of a Tx relative to alternative use of resources

18

Why does NICE guidance replace local recommendations?

Provide equal access across the country so effective and cost-effective interventions are made available quickly

19

What happens if an intervention receives NICE approval?

Local NHS organisations must fund if clinically appropriate, thus removing funding from elsewhere

20

What happens if NICE does not approve an intervention?

Pts are effectively denied access except for individual requests

21

What is the purpose of health economics?

Provide info to assist allocation of scarce resources to maximise social benefits

22

What is the need for economic assessment?

Bring reality of fixed NHS resources to public attention, expose opportunity costs, enable consistency in investment, direct innovation, help make principles of allocation explicit, help Dr's to understand/contribute to evidence

23

What are the basic concepts in health economics?

Scarcity, efficiency, equity, effectiveness, utility, opportunity cost

24

Describe the concept of scarcity in healthcare economics.

Need outstrips resources therefore prioritisation is inevitable

25

What is technical efficiency?

Most efficient way of meeting a need

26

What is allocative efficiency?

Choosing between many needs to be met for the population

27

What is utility in healthcare economics?

Value an individual places on their health state

28

What is opportunity cost?

Value of next best use of resources measured in benefits foregone

29

What is the aim of investigating opportunity cost?

From a limited budget want to find the most efficient mix of services generating the greatest aggregate benefit

30

What are the implications of trying to find the greates aggregate benefit from a limited budget?

Ethical due to different conceptions of welfare

31

What is economic evaluation of healthcare underpinned by?

Scarcity, efficiency, opportunity cost and utility

32

What costs are considered in healthcare economics?

Healthcare services, pt's time, care-giving, ilness, economic costs borne by employers and society

33

What benefits are measured when using economic evaluation in healthcare?

Impact on health status, savings in other healthcare resources, increased productivity with sooner return to work

34

What are the problems with economic evaluation of healthcare?

Assumptions built into approach may influence conclusion, some health benefits are not felt for some years

35

How can problems associated with economic evaluation of healthcare be resolved?

Use of sensitivity analysis to check effects of assumptions. Discounting to take calculate present values of inputs and outcomes that accrue in the future

36

What are the 4 types of economic evaluation of healthcare?

Cost minimisation analysis, cost effectiveness analysis, cost benefit analysis, cost utility analysis

37

What is cost minimisation analysis?

Outcomes are equivalent (benefits all the same) so focus is on cost

38

Why is cost minimisation analysis not often relevant?

Outcomes are rarely equivalent

39

Give an example of cost minimisation analysis.

Improvements to mobility for different hip prostheses are equal so chose the cheapest

40

What is cost effectiveness analysis?

Comparison of interventions that have a common health outcome in terms of cost per unit outcome

41

What question does cost effectiveness analysis ask?

Is extra benefit worth extra cost?

42

What is cost benefit analysis?

All opin outs and outputs are valued in monetary terms to allow comparison outside of healthcare

43

What difficulties are seen in cost benefit analysis?

Methodological: putting monetary value on non-monetary benefits e.g. Willingness to pay

44

What is cost utility analysis?

Focuses on quality of health outcomes produced or foregone most frequently by QALY

45

What do QALYs combine to evaluate healthcare?

Quality and quantity of life

46

What does 1 QALY equal?

1 year of perfect health/10 years of 0.1 QoL/2 years at 0.5 QoL/6 months at 1 QoL for 2 people

47

What are the problems associated with the evidence used for QALYs to evaluate healthcare?

RCTs not perfect evidence, comparison Tx differ, length of follow-up implications, atypical pts and care, limited generalisability, sample size implications

48

Name some alternatives to QALYs.

Health Year Equivalents (HYEs), Saved-Young-Life-Equivalents (SAVEs), Disability Adjusted Life Years (DALYs)

49

What are the problems associated with NICE use of QALYs?

Resented by pts and pharma, CCGs prioritise NICE-approved interventions with unintended consequences to opportunity costs, political interference

50

How do NICE use QALYs?

Technology appraisals of clinical and cost effectiveness with consultation involving identification of topics, scoping, assessment and appraisal

51

How does the cost per QALY influence NICE approval?

£30k needs a strong case

52

Who is involved in the NICE use of QALYs?

DoH, professionals, pts, carers, public, health technology assessment groups, committees

53

What are the disadvantages associated with using QALYs to evaluate healthcare?

Values embodied, distribution of resources is not by need, may disadvantage common conditions, technical problems, data unrepresentative, impact on carers

54

How is cost effectiveness calculated using QALYs?

Calculate QALYs with and without intervention. Subtract to find QALYs gained. Divide total cost (cost per annum times life expectancy) by QALYs gained