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Flashcards in Session 8 Deck (20):
1

Why has money demands increased for the NHS?

Ageing population
Better technology
Better treatments

2

What are the 5 D's?

Explains rationing within the NHS
Denial of services
Deference - discouraging
Deterence - moving them onto another resource
Dilution of quality
Delay - waiting times

3

What is explicit rationing?

This is where rationing is based upon certain criteria and evidence
Decisions made by CCG's
Efficiency and equity accounted for

4

What are the advantages of explicit reasoning?

evidence based
more opportunities for equity
transparent
accountable
debate

5

What are the disadvantages of explicit reasoning?

Complex
Patient hostility
Patient distress
Threat to clinical freedom

6

What is implicit rationing?

This is what used to be used within the NHS, where clinicians had to allocate resources with no protocols, just on what they thought but then this lead to bias and inequity etc..

7

What are the different levels of rationing?

1. How much money the NHS gets in comparison to other public sectors
2. How much each sector within the NHS gets
3. How much is given to subdivisions of these
4. Which patient gets the treatment
5. How long the patient gets the treatment

8

Explain how NICE makes judgements?

NICE evaluate treatments that are expensive using QALY's
If approved by NICE, then healthboards around the UK have to offer that treatment to patients
If NICE decline it, then it is effectively denied to ALL patients
Weigh out costs and clinical benefit

9

What are Tariffs?

The hospitals get a certain amount of money for a procedure, but if they can do it for cheaper then they get to keep the change to reinvest. However, if its more expensive it comes out of their budget.
Also penalised for never events

10

Why isn't it good to let the public influence NHS budget?

Selfish
Not objective
Not enough knowledge
Don't think about the cost
Value heroic interventions

11

What are the concepts of health economics?

Effectiveness
Equity
Efficiency
Scarcity
Opportunity cost

12

Define technical choice

This is where you are interested in the most efficient way of meeting a need

13

Define allocative choice

This is where you are choosing between many needs that need to be met

14

What are the categories of cost?

Cost of service
Treatment
Patient time
Employee
Illness cost

15

What are the benefits on spending money?

Saving in other resources
Improved productivity of patient
Improved survival
Improved quality of life

16

What does QALY stand for?

Quality Adjusted Life Year

17

Explain QALY

one perfect year = 1 QALY
used to define treatment and how effective it will be in improving quality of life
measured by HR-QoL such as EQ-5D
NICE uses it in decision making

18

How does NICE use QALY?

Uses it in combination with cost effectiveness
30k then you need a lot to pass it

19

What are the disadvantages of QALY?

Every patient is different
There are exceptions
Usually small sample sizes
Public hate them
Generalisability

20

What are some alternatives to QALY?

DALY - disability adjusted life year
SAVEs - saved young life equivalent
HYE - health year equivalent