(8) Resource Allocation Flashcards
What are the five aspects of rationing in the NHS?
The 5 D’s:
- Deterrent: e.g. prescriptions
- Delay: waiting lists
- Deflection: e.g. GP as gatekeepers
- Dilutions: e.g. cheaper drugs and tests
- Denial: alternative services e.g. mental health consoling
What is explicit rationing?
Providing services according to defined rules used in systemic institutional allocations
What are some of the advantages of explicit rationing (4)?
- Equality
- Enable debates
- Based on clinical evidence
- Transparent
What are some of the disadvantages of explicit rationing (5)?
- Complexity
- Heterogeneity between patients
- Patient professional hostility
- Limited clonal freedom
- Proved patient distress
What is implicit rationing?
Individual clinical decisions without following defined rules
Who makes the explicit rationing decisions?
Clinical Commissioning Groups
What do the government have to consider when deciding rationing in healthcare (5)?
- How much to the NHS compared to other government priorities e.g. education etc
- How much to each sector e.g. mental health, social care
- How much to each intervention
- How to allocate between patients
- How much benefit to gain from each PATIENT
How do tariffs work?
- Payment by results
- Information of treated patients is recorded, results of the efficiency determine the earn or loss
What is the effect of ‘never-events’ on tariffs?
Zero payment if avoidable complications occurred
What is the opportunity cost?
The cost is view as a sacrifice for better policy, interventions etc so that the other opportunities for using those resources are foregone
What are the two types of explicit rationing?
- Technical process (assessment of efficient and equity)
- Political process (lay participation)
How is cost utility analysis measured?
QALYs = Quality Altered Life Years
Why is rationing in healthcare inevitable (4)?
- Ageing populations, more elderly people requiring services
- Improved technology prolonged patients’ lives without curing
- Resources are scarce
- Clear who benefits from public expense and whether it is actually worth it
What is the main function of NICE?
- Approvals of new drugs, devices etc based on clinical benefits, costs etc.
- Enable evidence of clinical and cost effectiveness for national judgement compared to alternative choices.
What are the monetary considerations (economic evaluation) in implementing a new drug (4)?
- Cost minimisation analysis - outcomes assumed to be equivalent, so choose the cheapest one
- Cost effectiveness analysis - compare interventions of those with a common outcomes e.g. reduction in blood pressure per unit cost
- Cost benefits analysis - all inputs and outputs valued in monetary terms
- Cost utility analysis - quality of health outcomes produced or foregone commonly using QALY
