Flashcards in Session 8 Deck (20):
Why has money demands increased for the NHS?
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
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
What are the advantages of explicit reasoning?
more opportunities for equity
What are the disadvantages of explicit reasoning?
Threat to clinical freedom
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..
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
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
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
Why isn't it good to let the public influence NHS budget?
Not enough knowledge
Don't think about the cost
Value heroic interventions
What are the concepts of health economics?
Define technical choice
This is where you are interested in the most efficient way of meeting a need
Define allocative choice
This is where you are choosing between many needs that need to be met
What are the categories of cost?
Cost of service
What are the benefits on spending money?
Saving in other resources
Improved productivity of patient
Improved quality of life
What does QALY stand for?
Quality Adjusted Life Year
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
How does NICE use QALY?
Uses it in combination with cost effectiveness
30k then you need a lot to pass it
What are the disadvantages of QALY?
Every patient is different
There are exceptions
Usually small sample sizes
Public hate them