8) Resource Allocation Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What are the five D’s of rationing in the NHS?

A
  • Deterrent (might not get prescription as it costs you money)
  • Delay (waiting list might put you off)
  • Deflection (gotta go via GP, so it doesn’t waste expensive service time)
  • Dilution (fewer tests, cheaper drugs that aren’t branded)
  • Denial (some services patients can’t get on NHS)
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2
Q

What is explicit rationing?

A

The use of institutional procedures for the systematic allocation of resources within health care systems. These are based on defined rules of entitlement which everyone can see.

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3
Q

What are some of the advantages of explicit rationing?

A
  • Transparent, accountable
  • Opportunity for debate
  • Use of evidence based practice
  • More opportunities for equity in decision-making
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4
Q

What are some of the disadvantages of explicit rationing?

A
  • Very complex
  • Heterogeneity of patients and illness (everyone very different - hard to prove why you picked them)
  • Hard to prove your reasoning
  • Patient and professional hostility
  • Threat to clinical freedom
  • Evidence of patient distress
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5
Q

What is implicit rationing?

A

The allocation of resources through individual clinical decisions without criteria for those decisions being explicit

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6
Q

When was implicit rationing stopped? Why?

A

It was stopped around 1990 because it can lead to inequities and discrimination (open to abuse, perceptions of “social deservingness”)

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7
Q

Why is rationing in healthcare inevitable?

A
  • Increasing amount of elderly people, need a cost vs. benefit
  • New technology increasing survival and not really curing - expensive
  • Resources are scarce
  • Clear who benefits from public expenditure and whether it is actually worth it (cost benefit)
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8
Q

Who makes the explicit rationing decisions?

A

Clinical commissioning groups with influence from the politicians?

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9
Q

What do the government have to consider when deciding rationing in healthcare?

A
  • How much allocation to NHS compared to other government priorities (education, defence)
  • How much to allocate across sectors (mental health, cancer)
  • How much to allocate to specific interventions within sectors (end of life drugs versus drugs with curative intent)
  • How to allocate interventions between different patients in the same group
  • How much to invest in each patient once an intervention has been initiated
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10
Q

What is the main function of NICE?

A

Set up to ‘enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources’. It appraises new drugs and devices based on clinical benefit, costs etc.

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11
Q

How do tariffs work?

A

These are payments for the results you achieve. So, when a patient is treated all their data is recorded and this information puts them in a group (Healthcare Resource Groups) based on how well they performed/how much they had to do. Efficient trusts can earn a profit, however, inefficient trusts can lose money.

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12
Q

What is the effect of ‘never-events’ on tariffs?

A

Never-events trigger a £0 payment for services rendered as they did a shitty job and did a bad thing.

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13
Q

What is effectiveness?

A

The extent to which an intervention produces desired outcomes.

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14
Q

What is the opportunity cost?

A

Once you have used a resource in one way, you no longer have it to use in another way. (you have to pick who you want to give the money to)

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15
Q

What are the monetary considerations (economic evaluation) in implementing a new drug?

A
  • Cost minimisation analysis (outcomes assumed to be equivalent, e.g. all hip prostheses improve mobility equally, so choose the cheapest one)
  • Cost effectiveness analysis (compare drugs or interventions which have a common health outcome, but there is different level of benefits)
  • Cost benefit analysis (all inputs and outputs valued in monetary terms, how much life you get etc.)
  • Cost utility analysis (quality of health outcomes produced or foregone commonly using QUALY)
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16
Q

What are some of the criticisms of QUALYs?

A
  • Do not distribute resources according to need, but according to the benefits gained per unit of cost
  • Technical problems with their calculations
  • May not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative of the population
  • RCT evidence (comparison therapies may differ, length of follow-up, atypical patients/care)
  • The values they embody
17
Q

What are QUALYs?

A

The amount of money that is spent to give one year of life in perfect health. So, one year in perfect health is equal to 10 years in 10% of health. The assessment of health measured using a generic HR-QoL instrument, e.g. EQ-5D

18
Q

Describe how QUALYs are used in cost-benefit analysis?

A

NICE assess cost-effectiveness by integrating the QUALY score with the price of treatment using the incremental cost-effectiveness ratio (ICER). Currently the max is £30, 000 apart from exceptional cases.

19
Q

What are the two types of explicit rationing?

A
  • Technical process (assessment of efficiency and equity)

- Political process (lay participation)

20
Q

How is cost utility analysis measured?

A

QUALYs