11. Health Inequalities Flashcards
Outline the importance of prioritisation in the NHS.
Demand for healthcare is greater than supply and resources.
How are drugs distributed in the UK?
Cost per QALY
(Expected number of years the patient has left if they take the drug x cost per year) / QALYs gained = cost per QALY
NICE’s cost effectiveness threshold is around £30,000 per QALY to be NHS funded.
What are the styles of reasoning when discussing resource allocation?
Explicit reasoning - predetermined rules of entitlement and transparency (ie. treatments supported by NICE if cost per QALY < £30,000).
Implicit reasoning - decisions without being clear about why the choices have been made.
What are the advantages and disadvantages of explicit reasoning?
Advantages:
- debatable and accountable
- evidence-based decisions
Disadvantages:
- outcomes are assumed to be the same for all
- distress if accounted to be ‘underserving’
What are the advantages and disadvantages of implicit reasoning?
Advantages:
- quicker because decision makers don’t spend time justifying their choices
Disadvantages:
- leads to inequality, favouritism, and discrimination
- social deservingness
- less accountable
What is technical efficacy?
The ability to get the most out of limited resources.
What is opportunity cost?
Once money has been invested in a resource, the opportunity cost is the ‘opportunity’ of investing in another resources that has been sacrificed.
What is allocative efficacy?
Distributing resources to meet as many needs as possible.
What is cost minimisation analysis?
All outcomes are assumed to be equivalent and focus is only on the inputs. The cheapest input is chosen.
What is cost effectiveness analysis?
Compares interventions that have a common outcomes. Compared in terms of cost per unit outcome.
What is cost benefit analysis?
All inputs and outputs are put in monetary terms and compared with inputs as ‘costs’ and outputs as ‘revenue’. The outcome with the best balance of costs vs revenue is chosen.
What is cost utility analysis?
Quality of health outcomes produced or foregone in QALYs. Cost per QALY.
What is the medical model of disease?
Symptoms > Diagnosis > Treatment > Cure
What is the social model of disease?
Person with different needs > Disabled by social barriers > Remove barriers > Enablement
What cognitive issues are homeless people at risk of?
- dementia
- depression
- premature death (average age of death is 47 years)
If a patient is homeless, how can they sign up to a GP?
