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Population Science > Introduction to Resource Allocation & Health Economic > Flashcards

Introduction to Resource Allocation & Health Economic Flashcards

1
Q

Describe priority settings

A

Decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care.

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2
Q

Describe rationing

A

The effect of those decisions (based on priority settings)on individual patients, that is, the extent to which patients receive less than the best possible treatment as a result.

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3
Q

In combination, how can priority setting and rationing be understood?

A

Processes by which services that may be of benefit to users are withheld on grounds which include cost

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4
Q

Why set priorities?

A

Scarcity of resources

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5
Q

Why are ethics important when priority setting?

A

Need to be clear and explicit about what we are trying to achieve and who benefits from public expenditure

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6
Q

State and describe two types of rationing

A

Explicit rationing- based on defined rules of entitlements. (The use of industrial procedures for the systemic allocation of resources within health care system)

Implicit rationing- care is limited but neither decisions, nor the bases for those decisions, are clearly expressed. (Allocation of resources through individual clinical decisions without criteria for decisions being explicit)

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7
Q

State four issues with implicit rationing

A
  • lead to inequities
  • open to abuse
  • decisions based on perceptions
  • doctors appear increasingly unwilling to do so
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8
Q

State five disadvantages of explicit rationing

A
  • very complex
  • heterogeneity of patients and illness
  • patient and professional hostility
  • impact on clinical freedom
  • some evidence of patient distress
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9
Q

State four advantages of explicit rationing

A
  • transparent/accountable
  • opportunity for debate
  • more clearly evidence based
  • more opportunities for equity in decision-making
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10
Q

What does NICE stand for?

A

National Institute for Health and Care Excellence

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11
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.

Guidance on whether treatment (new or existing) can be recommended for use.

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12
Q

What type of rationing is generally used in the NHS now?

A

Explicit rationing

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13
Q

State what happens if NICE:

  • Approve a drug
  • Do not approve a drug
A

Approve: local NHS must fund the (sometimes with adverse consequences for other appropriate priorities)

Do not approve: patients are effectively denied access to them (except for individual requests)

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14
Q

Define scarcity

A

Need outstrips resources. Prioritisation is inevitable.

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15
Q

Define efficiency

A

Getting the most out of limited resources

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16
Q

Define equity

A

The extent to which distribution of resources is fair

17
Q

Define effectiveness

A

The extent to which an intervention produces desired outcome

18
Q

Define utility

A

The value an individual places on health state

19
Q

Define opportunity cost

A

Once you have used a resource in one way, you no longer have it to use in another way.

The opportunity cost of the new treatment is the value of the next best alternative use of those resources. Cost is viewed as a sacrifice rather than an expenditure. Measured in BENEFITS FOREGONE.

20
Q

State and describe two types of efficiency

A

Technical efficiency- interested in the most efficient way of meeting a need

Allocative efficiency- choosing between the many needs to be met

21
Q

What is economic evaluation?

A

Comparison of resource implications and benefits of alternative ways of delivering care. It can facilitate decisions so that they are more transparent and fair.

22
Q

When you measure costs you must identify, quantify and value resources needed; state 5 “areas/examples” of cost.

A
  • Cost of the patients time
  • Cost of healthcare services
  • Costs associated with care-giving
  • Other costs associated with illness
  • Economic costs borne by the employers, other employees and the rest of society
23
Q

State three ways you can measure benefits

A
  • Impact on health status
  • Savings in other healthcare resources
  • Improved productivity
24
Q

State the four ways you compare costs and benefits?

A
  • cost minimisation analysis
  • cost effectiveness analysis
  • cost benefit analysis
  • cost utility analysis
25
Q

Describe cost minimisation . Is it relevant?

A

Outcomes assumed to be equivalent. Focuses only on costs.

Not often relevant as outcomes rarely equivalent.

26
Q

Describe cost effectiveness analysis.

A

Used to compare drugs or interventions which have common health outcome. Compared in costs per unit outcomes. If costs are higher for one treatment, but benefits are too, need to calculate how much extra benefit is obtained for the extra cost.

Is extra benefit worth extra cost?

27
Q

Describe cost benefit analysis. What are the main difficulties with this method?

A

All inputs and outputs valued in monetary terms. Can allow comparison with interventions outside healthcare.

Methodological difficulties e.g. putting monetary value on non-monetary benefits such as lives saved

28
Q

Describe cost utility analysis

A

Particular type of cost effectiveness analysis. Focuses on quality of health outcomes produced or foregone.

Most frequently used measure is QALY. Interventions are compared in cost per QALY terms.

29
Q

What is QALY?

A

Quality adjusted life year. It’s a composite of survival and quality of life.

30
Q

What does 1 year of perfect health equate to in QALYS?

State two interpretations of 1 QALY?

A

1 year perfect health= 1 QALY

1 QALY= 10 years with 0.1 perfect health OR 1 year perfect health

31
Q

Describe how we use QALY and costs to determine if treatment is cost effective

A
  • define quality of life (0-1)
  • define how many years expected to live with this quality of life
  • calculate QALY
  • calculate QALY gained
  • calculate total cost
  • calculate cost per QALY gained
32
Q

State 3 alternatives to QALYS

A
  • health year equivalents (HYEs)
  • saved young life equivalents (SAVEs)
  • disability adjusted life years (DALYs)
33
Q

State cost ranges for which QALYS are accepted, discussed or rejected.

A

Accepted - below £20000 per QALY
Discussed - £20000-£30000 per QALY
Rejected/further discussion - above £30000 per QALY

34
Q

State some issues with using QALYS.

A
  • Controversy about values they embody (what is important to one person may not be as important to the next person)
  • May disadvantage common conditions
  • QALYS do not asses impact on families of carers
  • May disadvantage common conditions

Population Science (20 decks)

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