8) Resource Allocation Flashcards
What are the five D’s of rationing in the NHS?
- 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)
What is explicit rationing?
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.
What are some of the advantages of explicit rationing?
- Transparent, accountable
- Opportunity for debate
- Use of evidence based practice
- More opportunities for equity in decision-making
What are some of the disadvantages of explicit rationing?
- 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
What is implicit rationing?
The allocation of resources through individual clinical decisions without criteria for those decisions being explicit
When was implicit rationing stopped? Why?
It was stopped around 1990 because it can lead to inequities and discrimination (open to abuse, perceptions of “social deservingness”)
Why is rationing in healthcare inevitable?
- 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)
Who makes the explicit rationing decisions?
Clinical commissioning groups with influence from the politicians?
What do the government have to consider when deciding rationing in healthcare?
- 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
What is the main function of NICE?
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.
How do tariffs work?
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.
What is the effect of ‘never-events’ on tariffs?
Never-events trigger a £0 payment for services rendered as they did a shitty job and did a bad thing.
What is effectiveness?
The extent to which an intervention produces desired outcomes.
What is the opportunity cost?
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)
What are the monetary considerations (economic evaluation) in implementing a new drug?
- 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)