09-03-23 – Healthcare resources Flashcards
Learning outcome
- Describe variations in healthcare utilisation and discuss the underlying reasons.
- Explain the concept of equity in healthcare
- Describe the taxonomy of need, and identify the stakeholders involved in decision-making around healthcare priorities
- Describe the broad strategic approach to setting healthcare priorities
Why was the NHS said to be “founded on a fallacy”?
- Why the NHS was said to be “founded on a fallacy”:
- “.. the NHS was founded on a fallacy: that there was a finite amount of ill-health in the population which, once removed, would result in the maintenance of health and the provision of healthcare becoming cheaper as the need for it dropped off. What has happened is that success in healthcare has resulted in people living longer potentially to be ill more often and therefore consume more resources”
What year was the NHS founded?
What are 3 founding principles of the NHS?
What are 6 principles in the 2011 NHS constitution?
- The NHS was founded in 1948.
- 3 founding principles of the NHS:
1) That it meet the needs of everyone
2) That it be free at the point of delivery
3) That it be based on clinical need, not ability to pay - 6 principles in the 2011 NHS constitution:
1) The NHS provides a comprehensive service available to all
2) Access to NHS services is based on clinical need, not an individual’s ability to pay
3) The NHS aspires to the highest standards of excellence and professionalism
4) The NHS aspires to put patients at the heart of everything it does * The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
5) The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources
6) The NHS is accountable to the public, communities and patients that it serves
What are 4 different types of need (in picture)?
What are 9 strategies to resource allocation?
- 9 strategies to resource allocation:
1) Equal access to treatment
2) Rationing according to clinical need
3) Maximising health gains (QALY)
4) Discriminating according to age
5) Taking individual responsibility for ill health into account
6) Rationing according to ability to pay
7) Singling out certain types of excluded treatment
8) Dilution of care
9) Random allocation
How much money is used to fund preventative healthcare?
What is the cost per QALY in terms of public health expenditure and healthcare expenditure?
What is the median return on investment for public health interventions?
- ‘The Office for National Statistics UK Health Accounts attributes around 5% of total UK Government healthcare expenditure to preventive healthcare’
- Centre for Health Economics, University of York: ‘Cost per QALY calculations reveal that public health expenditure, at about £3,800 per QALY, appears to be about three to four times more productive at the margin than healthcare expenditure (which costs about £13,500 per QALY).
- The median return on investment for public health interventions was 14.3 to 1 (Masters, et. al, 2017)
What is the difference between equality and equity?
What is Aristotle’s theory of distributive justice?
- Equality = treating everyone the same
- Equity = treating everyone fairly
- Aristotle’s theory of distributive justice:
- Horizontal equity refers to equity between people with the same health care needs
- Policy and guidelines
- Vertical equity refers to those with unequal needs who should receive different or unequal health care
- NICE, SMC cost per QALY
What is the School Health Service (1907- 1948)?
Why was it implemented?
What did it lead to?
- The School Health Service (1907- 1948) was a pre-cursor to the NHS
- It was implemented in order to improve the physical health of those in the UK in order to ‘maintain the empire’
- It led to legislation to improve maternal and child health, air quality, open spaces and schools.
What are 5 reasons we have healthcare?
- 5 reasons we have healthcare:
1) Human right? – ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.’
2) Because it is a nice thing to do?
3) So that we can fight wars?
4) So that we can work to be able to afford health care?
5) To live good lives?
Describe the ‘Health is made at home, hospitals are for repairs’ view
- ‘Health is made at home, hospitals are for repairs’ view
- Nigel Crisp – former NHS Chief Executive and Permanent Secretary to the Department of Health:
- “the NHS can’t by itself deal with many of today’s major health problems such as loneliness, stress, obesity, poverty and addictions. It can only react, doing the repairs but not dealing with the underlying causes. … There are people all over the country who are tackling these causes in their homes, workplaces and communities. … They are not just preventing disease but creating health. And they take pressure off the NHS, so it is always there when we need it.”
Resource allocation summary
- Resource allocation summary
- Both the supply (resources) and demand (need) need to be considered and are changing
- Different moral and ethical approaches can inform the difficult decisions about resourcing health care
- Is health care integral to society or a ‘nice to have’?
- Is health care just the NHS or all of us?
