Session 8 - Resource Allocation and Healthcare Economics Flashcards
Why set priorities in healthcare?
Resources are scarce
So it is clear and explicit who benefits from public expenditure
We need to be clear about whether spending is worth it
Be clear about what we are trying to achieve
What are the 5D’s in rationing in the NHS?
Deterrent - demands for healthcare are obstructed - prescription and dental charges
Delay - waiting lists
Deflection - GP deflect demand from secondary care - gatekeepers
Dilution - Fewer tests, cheaper drugs
Denial - range of services denied to patients e.g. reversal of sterilisation, infertility treatment.
What is implicit rationing?
Advantages and Disadvantages?
Allocation of resources based on individual clinical decision with no criteria for those decisions.
However this can lead to inequalities and room for discrimination.
Open to abuse
Decision based on perceptions of social deservingness.
But is more sensitive to the complexity of medical decisions, need and personal and cultural preferences of the patient.
What is Explicit Rationing?
Advantages and Disadvantages?
Use of institutional procedures in the allocation of resources. Care is limited and the decision is explicit. The criteria used to make the decisions must be able to be explained and justified to the public.
Advantages - trasnparent and accountable, opportunity for debate, use of EBP, more opportunities for equality in decision making.
Disadvantages - Very complex, patients are heterogeneous, patient and professional hostility, threat to clinical freedom, evidence of patient distress.
What is the role of NICE?
To create guidance and approves interventions based on evidence of efficiency and on cost. It helps to remove inequalitites across the county as once NICE makes a decision all hospitals must implement it.
What is the role of NICE?
To create guidance and approves interventions based on evidence of efficiency and on cost. It helps to remove inequalities across the county as once NICE makes a decision all hospitals must implement it.
What are the basic concepts of health economics?
Scarcity - need outstrips resources
Efficiency - getting most out of limited resources
Equity - extent to which distribution of resources is fair
Effectiveness - extent to which an intervention produces desired outcomes
Utility - the value an individual places on a health state
Opportunity cost - the next best way resources could have been spent. Measured in benefits foregone.
What are the basic concepts of health economics?
Scarcity - need outstrips resources
Efficiency - getting most out of limited resources
Equity - extent to which distribution of resources is fair
Effectiveness - extent to which an intervention produces desired outcomes
Utility - the value an individual places on a health state
Opportunity cost - the next best way resources could have been spent. Measured in benefits foregone.
What is technical efficiency?
Most efficient way of meeting a need - e.g should antenatal care be community or hospital based?
What is allocative efficiency?
Choosing between the many needs that have to be met e.g. should we fund hip replacements or neonatal care?
What are different types of costs?
Medical - treatment, health professional visits etc.
Non-Medical - time off work, travel costs etc.
What are different types of benefits?
Survival, Monetary, Clinical criteria, QoL
How can you measure costs?
Cost of heath care services Costs of patients time Costs associated with care-giving Other costs associated with illness Economic costs borne by employers, rest of society
How can you measure benefits?
Impact on health status
Savings in other health care resources - drugs, hospitalisation, procedures
Improved productivity of patient, family members can return to work earlier.
What are the four types of economic evaluation?
Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis
