Decision making Flashcards
What is health economics?
*The study of how peopleand societyend up choosing to employ scarce productive resources (alternative uses)
*… to produce various commodities and distribute them for consumption (now/ in future)
*… among various persons/ groups in society
Efficiency
A measure of the relationship between the results achieved and the resources expended. All about maximising the outcomes for a given amount of resources.
Equality
All people should be treated equally
Equity
recognition that health care should be fairly available to all members of society irrespective of ability to pay
–Horizontal equity: equal; access to health care to those with equal needs
–Vertical equity: how people with different needs should be treated differently/ unequally.
Inequity
those differences in health (between groups) that are avoidable and are considered unfair OR that reflect OR are the consequence of an underprivileged position AND can be fixed.
A way of improving equity in the health system
improving people’s access to health care.
Universal coverage
*The WHO defined a universal health system as one that provides all citizens with adequate health care at an affordable cost.
*Key elements of universal health care coverage:
–Everyone is able to use health services when needed (access)
–Provides financial protection against the cost of health care for everyone
NHI strategy rationale
- Pooled (publicly controlled) resources
will provide means to exercise greater
public control over health financing
which will in turn allow for: - better integration of the health care
system, - increased cross-subsidation,
- more concentrated purchasing
power and purchasing efficiency
NHI strategy approach
- Reallocation of medical aid tax credits
- Increase taxes:
- General taxes
- Payroll tax, etc.
Challenges to UHC
*Scarce resources
*We need to choose how we use them to achieve UHC
*Need to consider the opportunity costs of resources that may have been used differently
*One way of evaluating and prioritising resources…economic evaluation
What is an economic evaluation
*Comparative analysis of costs and consequences of alternative courses of action.
–Weighing up inputs vs the resulting outputs
–To contain costs and manage demand
–To maximise the benefits from health care spending.
–Improve decisions around the allocation of health care resources
–Identify ways to redirect resources to achieve more
–Identify neglected opportunities that are relatively inexpensive
–To overcome regional variations in access.
–To provide bargaining power with suppliers of health care products
How to do an economic evaluation
*Perspective
–Health care providers
*Costs of providing the service (infrastructure, staff salaries and medication)
*Key indicators: change in number of deaths
–Patient/ household perspective
*Include cost of accessing care (travel costs, loss of income, time)
*i.e. OOP and value of time
Types of economic evaluation
- cost effectiveness
- cost utility
- cost benefit
- cost minimisation
- cost consequences
cost effectiveness
evaluates two or more policy alternatives in terms of their relative costs and outcomes, where the outcomes are measured in a single natural unit (e.g. disease case averted)
cost utility
Evaluates two or more policy alternatives in terms of their relative costs and outcomes, where the outcomes are expressed by a generic measure of health status that considers both the effect on mortality and morbidity (e.g., quality-adjusted life-years (QALYs) and
disability-adjusted life-years (DALYs)).
cost benefit
Evaluates two or more policy alternatives in terms of their relative costs and outcomes, where both the costs and outcomes are expressed in monetary terms. In principle, it should value the interventions
relevant costs and outcomes based on the preferences of those affected (i.e., the individuals’ willingness to pay).
cost minimisation
Compares the costs of two or more policy alternatives which are all assumed to have equivalent health effects.
cost consequence
Evaluates two or more policy alternatives in terms of their relative costs and outcomes, where the outcomes are not summarised in a single measure, and multiple outcomes of interest are
reported.
What does “Threshold” refer to in healthcare policy?
In healthcare policy, a “Threshold” refers to the societal value placed on living longer and healthier lives, which guides decisions on the allocation of healthcare resources.
Is there an explicit threshold policy worldwide?
No, explicit threshold policies exist in some parts of the world, but much of the developing world does not have such policies in place.
Why are threshold policies important?
Threshold policies are important because they help determine how resources are allocated to various health interventions, aiming to maximize the societal value of health improvements and longevity.
What is a potential consequence of not having a threshold policy?
Without a threshold policy, there may be inconsistencies and inequities in how healthcare resources are distributed, potentially leading to suboptimal health outcomes and inefficient use of resources.
What is a key criticism of the “one size fits all” threshold approach?
A key criticism is that it is unlikely a “one size fits all” threshold is sensible, as different populations and health conditions require tailored approaches.
Why is the threshold concept considered a value?
The threshold concept is considered a value because it differs depending on factors like the burden of disease, severity of conditions, and characteristics of the population in need.
