S9 Flashcards
Explain the inevitability of priority-setting in healthcare systems
there is a scarcity of resources- demand outstrips supply thus difficult decisions must be made. Must be clear and explicit about what we are trying to achieve and who benefits from public expenditure
What is demand driven by regarding priority-setting?
Demographics- aging population, over 65s with long-term conditions, increased incidence and prevalence of cancer
What is priority setting?
Priority setting describes the decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care. AKA explicit rationing
What is rationing?
The effect of priority setting decisions on individual patients- the extent to which patients receive less than the best possible treatment as a result
What are the two forms of rationing?
Explicit rationing and implicit rationing
What is implicit rationing?
The allocation of resources through individual clinical decisions without the criteria for those decisions being explicit. Thus= open to abuse, lead to inequities and discrimination
What are the positives of explicit rationing?
Transparent, accountable, more evidence-based, more opportunities for equity in decision-making
What are some disadvantages of explicit rationing?
Very complex patient and professional hostility, heterogeneity of patients and illnesses
Describe a range of approaches to resource allocation in healthcare
Rationing system
Health economics: what is scarcity?
Need outstrips resources- prioritisation is inevitable
Health economics: what is efficiency?
Getting the most out of limited resources
Health economics: what is equity?
The extent to which distribution of resources is fair. Giving everyone a share according to their need.
Health economics: what is effectiveness?
The extent to which an intervention produces desired outcomes
Health economics: what is utility?
The value an individual places on a health state
Health economics: what is opportunity cost?
the loss of other treatments when one treatment is chosen- the opportunity cost of the new treatment is the value of the next best alternative use of those resources
what is opportunity cost measured in?
benefits foregone
What is allocative efficiency?
You are choosing between the many needs to be met (e.g. fund hip replacement or neonatal care)
How do you measure costs?
Identify, quantify and value resources needed
How do you measure benefits?
Impact on health status, savings in other healthcare resources, improved productivity
What is economic evaluation?
Comparison of resource implications and benefits of alternative ways of delivering healthcare. Facilitates decisions so that they are more transparent and fair
What are the components to economic evaluation?
Costs to- NHS, whole public sector, patient. Resources saved
Consequences- health state change, other gains e.g. employment
What are the types of economic evaluation?
Cost minimisation analysis, cost effectiveness analysis, cost benefit analysis, cost utility analysis
What is cost minimisation analysis?
A method of comparing the costs of alternative interventions with the assumption that they have equal outcomes.
Focuses on costs (i.e only the inputs)- cheapest option preferable. Not often relevant as the outcomes rarely equivalent.
What is cost effectiveness analysis?
Compares the relative costs and outcomes (effects) of different courses of action
Comparison of drugs/interventions which have a common health outcome e.g. reduction in blood pressure.
Cost per unit outcome-is the extra benefit worth the extra cost
