8. Cost Containment Flashcards
QALYs?
Quality adjusted life year. It’s how much additional life is going to be achieved by some sort of policy/expenditure?
What measures are included in quality of life? Range?
Mobility, pain/discomfort, self-care, anxiety/depression, and usual activities (3 of EACH). If you figure out ALL the combinations you get like, 245 combinations..mixture of these characteristics gives an estimate/sense of how the individual is living (although it depends on who’s measuring). It ranges from ZERO TO ONE.
How to figure out additional QALY’s for expenditure A v. B?
(Times * Quality of A) ? (Times * Quality of B) = # additional LY
Cost Utility Ratio?
( Cost of A - Cost B ) / (QALY’s from A - QALY’s from B)
How to interpret CUR?
Spend $ ### per additional QALY for that target population.
UK and QALYs?
Policy makers in UK think — what?s a statistical life worth ($7m)?divide into small pieces to get a QALY. Conclusion? 50k is a good number. This is a political/philosophical decision ? not an economical/mathematical decision
When considering implementing something, what 4 things should you factor in?
Quality, access, cost, and equity
How has life expectancy changed since 1960? What has accounted for a large part of it?
Life expectancy has gone up in all age group 1960 - 2000 (gone up MOST in newborns, least for 65+). Medical care accounts for HALF of this (mostly from HD and neonatal death reductions)
How has HD helped?
Treatment has led to > 4 year increase in number of expected life years among the same newborns
> 4 years for HD, pretty damn good…how much did that cost?
We?re spending A LOT MORE for average person who?s born today then who?s born in 1960. Also, we’re assuming that medical care is 100% of the reason for increased life expectancy, and the outcome is very sensitive to that.
How has spending per year of life gained changed from 1960 - 2000?
Decrease from 1960?1970 (fruitful period for effective medical interventions (in improvements in myocardial disease, deaths)). We?re beginning to spend more money per year of life gained for all age groups (As we go along it?s getting harder and more expensive to get the same gains).
What about if we look at medical AND social service expenditures?
Health expenditure add years of life, but not ONLY thing?but social expenditures (at the population level) can ALSO buy extended years of life.
US v. Sweden social/health expenditures?
Sweden has much more percentage of GDP spent on social support services (child care, housing subsidies, unemployment insurance). WE spend a lot less than Sweden on social services and a lot more on health services, we’re spending way more on health services as percentage of GDP and we’re sort of in the middle regarding social services, with respect to other countries.
3 ways to lower use of harmful products?
Raise price, especially through taxes, Limit access?hours, locations, quantities, Limit promotion?counter advertising
3 ways to regulate potentially harmful behavior?
Licensing, penalties, minimum age/other standards
