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Population and Social Science > L15- Resource allocation and health economics > Flashcards

L15- Resource allocation and health economics Flashcards

1
Q

NHS is in crisis due to

A

budget cuts

- must make hard decisions with regards to where money is spent

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2
Q

priority setting describes

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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3
Q

rationing describeds

A

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

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4
Q

why set priorities

A
  • Resources are scarce and could be used in many ways
  • Demand outweighs supply
  • Difficult decisions have to be made
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5
Q

demand driven by

A

changing demographics

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6
Q

changing demographics

A
  • Number of over 75s is rising
  • 60% of over 65s have LTC
  • Increased incidence and prevalence of cancer
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7
Q

ethics

A

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

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8
Q

two forms of rationing

A

explicit rationing

implicit rationing

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9
Q

explicit rationing

A

the use of institutional procedures for the systematic allocation of resources within health care system

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10
Q

with explicit rationing the decisions are made by an

A

administrative authority as to the amounts and types of resources to be made available, eligible populations

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11
Q

simple explicit rationing

A

specific rules for allocations

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12
Q

positives of explicit rationing

A
  1. transparent
  2. accountable
  3. opportunity for debate
  4. evidence based
  5. more opportunities for equity in decision-making
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13
Q

negative of explicit rationing

A
  1. very complex
  2. heterogeneity of patients and illnesses
  3. patient and professional hostility
  4. impact on clinical freedom
  5. patient distress
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14
Q

implicit rationing

A

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

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15
Q

with implicit rationing discretionary decisions are made by

A

managers, professionals, and other health personnel functioning within a fixed budgetary allowance

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16
Q

weaknesses of implicit rationing

A
  • Can lead to inequities and discrimination
  • Open to abuse
  • Decisions based on perceptions of social deservingness
  • Doctor appear increasingly unwilling to do it
    o e.g. Dr deciding not to give treatment of someone they don’t think worthy e.g. a criminal
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17
Q

NICE stands for

A

national institute of health and care excellence

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18
Q

NICE was set up to

A

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

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19
Q

NICE provides guidance on

A

whether treatments (new or existing) can be recommended for use in the NHS in England

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20
Q

NICE is asked to

A

• NICE is asked to appraise significant new drugs and devices to help make sure the effective and cost effective products are made available to patients quickly and to minimise variations in the availability of treatments

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21
Q

people dont like NICE because

A
  • controversial role inr elation to expensive treatments
  • ## if not approved patients are effectively denied access to them
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22
Q

if drug is approved by NICE

A

NHS mist fund them- with adverse consequences for other priorities

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23
Q

scaricity

A

need outstrips resources. Prioritisation is inevitable

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24
Q

efficiency

A

getting the most out of limited resources

25
equity
the extent to which distribution of resources is fair
26
effectiveness
the extent to which an intervention produces desired outcomes
27
utility
the value an individual places on health state
28
opportunity cost
once you have used a resource in one way, you no longer have it to use in another way
29
two types of efficiency
technical and allocative
30
technical efficiency
Interested in the most efficient way of meeting a need (e.g. should antenatal care be community or hospital based?)
31
allocative efficiency
Choosing between the many needs to be met ( e.g. fund hip replacement or neonatal care?)
32
opportunity cost explained
o When deciding to spend resources on a new treatment, those resources cannot now be used on other treatments
33
opportunity cost of the new treatment is the . value of the
next best alternative sue of those resoruces
34
cost is viewed as
sacrifice rather than financial expenditure
35
opportunity cost measured in
benefits forgone e.g. cost of IVF
36
opportunity cost of IVF
One course of IVF treatment is £2700. Three courses of IVF (£8100) increases probability of pregnancy by 30%. ``` Good value? Not a life threatening condition With £8100 could also fund: - Cochlear implant - 1 heart bypass operation - 11 cataract removals - 150 MMR vaccinations ```
37
economic evluation
Comparison of resource implications and benefits of alternative ways of delivering healthcare.  Used to make funding decisions more transparent and fair
38
how to measure cost
Identify, quantify and value resourced needed 1. cost fo the healthcare services 2. cost of patients time 3. cost associated with care-giving 4. other costs associated with illness 5. economic costs borne by employers, other employees and the rest of society
39
how do you measure benefits?
harder to measure- improved health hard to value 1. impact on health status 2. savings in other healthcare resources 3. improved productivity
40
types of evaluation which compare cost and benefit
1. cost minimisation analysis 2. cost effectiveness analysis 3. cost benefit anlysis 4. cost utility analysis
41
cost benefits analysis
all inputs and outputs valued in monetary terms - willingness to pay often used - can allow comparisons-with interventions outside healthcare
42
weakness of cost benefit analysis
methodological difficulties e..g putting monetary value on non-monetary benefits such as lives saved
43
cost minimisation analysis
outcomes assumed to be equivalent - focus on costs (only inputs) e. g. all prostheses for hip replacement improve mobility equally - choose the cheapest one
44
weakness of cost minimisation analysis
not often relevant as outcomes rarely equivalent
45
cost effectiveness analysis
used to compare drugs or interventions which have a common health outcome e.g. reduction in blood pressure compared in terms of cost per unit outcome e.g. cost per reduction of 5mm/Hg
46
with cost analysis 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
47
cost-utility analysis
particular type of effectiveness analysis
48
cost utility analysis focusses on
quality of health outcome produced or foregone uses QALYs intervention can be compared in costs per QALY terms
49
Quality adjusted life years
a measure of effectiveness of a treatment s
50
QALY incorporates
quality and quantity of life gained§ by a treatment
51
1 year of perfect health
1 QALY
52
2 years of 50% QOL
1 QALY
53
Example: man is diagnosed with cancer
Told he has 1 year to live if he does not have treatment • His quality of life, without treatment, will be 0.8 of perfect health and he will then die quickly • Without treatment = 0.8 QALYs • If he receives treatment he will live for 4 years, but his QoL will be 0.2 of perfect health • With treatment = 0.8 QALYs (4 x 0.2)  No gain in QALYS associated with treatment
54
alternatives to QALYs
- Health Year Equivalents (HYEs) - Save-young-life equivalents (SAVE) - Disability adjusted life years (DALYs)
55
NICE use
QALY
56
NICE and cost per QALY
below £20k per QALy will normally be approved
57
- £20-£30k per QALY
judgements will take account of: o Degree of uncertainty o If change in HRQoL is adequately captured in the QALY o Innovation that adds demonstrable and distinctive benefits not captured in the QALY
58
above £30k
need an increasingly stronger case
59
criticism of QALY
* Controversy about the values they embody * Do not distribute resources according to need, but according to the benefits gained per unit of cost * May disadvantage common conditions * Technical problems with their calculations * QALYs may not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative * QALYs do not assess impact on carers or family

Population and Social Science (14 decks)

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