Block 15 - part 3

Question 1

levels of resource allocation decisions

Answer 1

macro (societal), micro (clinical) levels

Question 2

macro level of resource allocation decisions

Answer 2

regard health funding v education or funding of certain drugs

Question 3

micro level of resource allocation decisions

Answer 3

individual decisions regarding care of individual patients

Question 4

arguments for age-based rationing being applied to macro level of resource allocation decisions

Answer 4

treatment and care of elderly people is very costly so ‘cost-effective’ argument might require resources elsewhere

Question 5

arguments against age-based rationing being applied to macro level of resource allocation decisions

Answer 5

most of the elderly burden related to the cost of illness and incapacity rather than age, young person with chronic/serious disease could also cost the same amount

Question 6

fair innings argument 1997

Answer 6

older people have had a longer life already, therefore fairer to divert resources to younger people. Elderly also have a disproportionate share of available resources allocated to them

Question 7

contraindications to fair innings argument 1997

Answer 7

treating on the basis of need might mean older people don’t receive lower priority, years of life saved shouldn’t matter, quality of life is more important e.g. QALYs, fairness is not only thing that matters, equal treatment matters

Question 8

arguments for age-based rationing being applied to micro level of resource allocation decisions

Answer 8

age should be rlevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk

Question 9

arguments against age-based rationing being applied to micro level of resource allocation decisions

Answer 9

age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination

Question 10

age discrimination

Answer 10

unjustifiable difference in treatment based solely on age

Question 11

direct age discrimination

Answer 11

direct difference in treatment based on age, cannot be justified

Question 12

indirect age discrimination

Answer 12

neutral provision or practice that has harmful repercussions on a person based on their age

Question 13

GMC view on age discrimination

Answer 13

must not unfairly discriminate against patients or let views about patient affect decisions

Question 14

law view on age discrimination

Answer 14

equality act 2010, protects age, sex, race, gender, disability, religion, etc

Question 15

QALY calculation

Answer 15

assign a utility value (0-1) to a state of health then multiply by number of years expected to live in this state, e.g. 0.5 QALY points x 5 years = 2.5 QALYs

Question 16

what leads to a utilitarian justification

Answer 16

QALYs focus on overall likely outcomes of resource allocations

Question 17

type of healthcare when cost per QALY is low

Answer 17

high priority, efficient health care

Question 18

type of healthcare when cost per QALY is high

Answer 18

low priority

Question 19

arguments for QALY based assessments

Answer 19

maximises healthcare based on quality and quantity of life, considers individual patient level when informing decisions about whether or not to proceed with and invasive procedure based on QALYs they are likely to gain

Question 20

arguments against QALY based assessments

Answer 20

difficulties in measuring - how do you measure quality of life? introduces bias, can seem unjust - can favour life years over individual lives

Question 21

relationship between age and QALY

Answer 21

older you are = fewer QALYs gained dure to lower life expectancy + co morbidities, doesn’t aim for ageism but is still indirectly discriminatory

Question 22

body which appraises medical technology in pounds per QALY

Answer 22

NICE