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Population Science > 8 - Resource Allocation and Healthcare Economics > Flashcards

8 - Resource Allocation and Healthcare Economics Flashcards

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1
Q

What is priority setting?

A

Decisions about the allocation of resources between the competing claims of different services, patient groups and care

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2
Q

What is rationing?

A

The effect of priority setting on individual patients, the extent to which the patients recieve less than the best possible treatment

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3
Q

Why do we have to set priorities?

A

Scarcity of resources, demand outweighs supply

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4
Q

What is implicit rationing and the disadvantages of it?

A

The allocation of resources through individual clinical decisions, without the criteria for these decisions being explicit

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5
Q

What is explicit rationing and the pros and cons of it?

A

Use of institutional procedures for the systematic allocation of resources within the healthcare system

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6
Q

Who is the main body of explicit rationing?

A

NICE - they set guidelines, that if approved, replace local recommendations. If on NICE local NHS must fund the treatment at the cost of other priorities

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7
Q

What is scarcity?

A

Need outweighs resources. Prioritisation is inevitable

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8
Q

What is efficiency?

A

Getting the most out of limited resources

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9
Q

What is equity?

A

The extent to which the distribution of resources is fair

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10
Q

What is effectiveness?

A

The extent to which an intervention produces desired outcome

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11
Q

What is utility in health economics?

A

The value an indiviual places on a health state

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12
Q

What is opportunity cost?

A
  • The opportunity cost of the new treatment is the value of the next best alternative use of those resources
  • Resources spent on a new treatment, now cannot be spent on other treatments
  • BENEFITS FOREGONE
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13
Q

What is technical efficiency?

A

The most efficient way of meeting a need

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14
Q

What is allocative efficiency?

A

Choosing between the many needs to be met

e.g hip replacement or neonatal care

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15
Q

What is economic decision-making?

A

BEST VALUE OF INVESTMENT

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16
Q

What are the ways of measuring costs of illness?

A
17
Q

How do you measure health benefits?

A
18
Q

What are the four ways of comparing costs and benefits?

A
19
Q

What is cost minimisation analysis?

A
  • Least used
  • All outcomes assumed to be equivalent, focus on costs and choose the cheapest one
  • e.g all prosthetics the same, choose the cheapest*
20
Q

What is cost effective analysis?

A

Compare drugs and treatments that have a similar outcome. Calculate how much extra benefit for extra cost

e.g blood pressure reduction

21
Q

What is cost benefit analysis?

A
  • All input and outputs are viewed in monetary terms
  • Methodology issues as difficult to put a price on saving a life
  • Allows comparisons with interventions outside healthcare
22
Q

What is cost utility analysis?

A
  • Type of cost effectiveness
  • Focuses on quality of health outcomes produced or foregone
  • Uses QALYS
23
Q

What is a QALY?

A
  • QUALITY ADJUSTED LIFE YEARS
  • Adjusts life expectancy for quality of life
  • 1 QALY is one year of perfect health
24
Q

How do you choose what type of economic evaluation to use?

A
25
Q

This same woman, with 16.1 QALYs (23 years of 70% perfect health) can take treatment and live for 23 years with 0.95 perfect health. The treatment is 50 GBP per annum.

What is the cost per QALY gained?

A
  • QALYs with treatment = 21.85 (0.95 x 23)
  • QALYs gained = 5.75 (21.85 - 16.7)
  • Total cost of treatment = £1,150 (23 x 50)

Cost per QALY gained = £200 (£1,150 / 5.75)

26
Q

What happens why there are no gains in QALYs?

A

It is a cost decison or the patients decision

27
Q

What are some alternatives to QALYs?

A
  • Health year equivalents (HYE)
  • Saved-young life equivalents (SAVEs)
  • Disability adjusted life years (DALYs)
28
Q

How does NICE make the decisions based on QALYs?

A

Below 20k = approved

20-30k = judgments taken into account, implicit rationing

Over 30k = very strong case

29
Q

What are some criticisms of QALYs?

A
  • May disadvantage common conditions
  • QALYs may not embrace all dimensions of benefit
  • Values expressed by experimental subjects may not be representative
  • QALYs do not assess impact on carers/family
  • Do not distribute acording to need but according to benefits gained per cost
  • Assumes every patient has equal advantages and disadvantages

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