Distribution of Healthcare

Question 1

Describe how the NHS was founded on a fallacy.

Answer 1

The NHS was founded on a fallacy: that there was a finite amount of ill-health in the population which, once removed, would result in the maintenance of health and the provision of healthcare becoming cheaper as the need for it dropped off. What has happened is that success in healthcare has resulted in people living longer potentially to be ill more often and therefore consume more resources.

Question 2

What are some of the reasons for the NHS being so overstretched?

Answer 2

• Increase in life expectancy
• Increasing costs of treatments
• Increase in patient expectations
• Increased cost of administration and salaries
• Free means less contraints on demand
• Increase in negligence cases

Question 3

What are the strategies for resource allocation?

Answer 3

• Equal access to treatment
• Rationing according to clinical need
• Maximising health gains (QALY)
• Discriminating according to age
• Taking individual responsibility for ill health into account
• Rationing according to ability to pay
• Singling out certain types of excluded treatment
• Dilution of care
• Random allocation

Question 4

What is the theory behind using QALY to allocate resources?

What is a QALY?

Answer 4

• Consequentialism (utilitarianism).
• It takes a year of healthy life expectancy to be worth 1, but regards a year of unhealthy life expectancy as worth less than 1. Its precise value is lower the worse the quality of life of the unhealthy person.

Question 5

How do you calculate QALY?

Answer 5

Question 6

What is the role of NICE?

Answer 6

• Provide evidence-based guidance and advice for health, public health and social care practitioners.
• Decision-making process is open and transparent.
• There are some criticisms:
  
  • Status of guidelines is ambiguous
  • Implementation is variable
  • Topic selection is not random

Question 7

What are the 4 technology appraisal reccommendations which can be offered by NICE?

Answer 7

1. Recommended for use in NHS
2. Restricted use to certain categories of patients
3. Use confined to clinical trials
4. Should not be used in NHS

Question 8

What is the Scottish Medicines Consortium (SMC)?

Answer 8

• The national source of advice on the clinical and cost-effectiveness of all new medicines for NHS Scotland.
• Aim is to ensure that people in Scotland have timely access to medicines that provide most benefit based on best available evidence.
• What does it do? It evaluates whether the benefits for patients may be considered an acceptable use of NHS resources.

Question 9

What are the possible decisions which can be made by the SMC about a particular drug?

Answer 9

• Accepted
• Accepted with restrictions
  
  • ​For example, the medicine can only be recommended in a particular group of patients with the condition. This typically occurs because the company has requested this explicitly in their submission.
• Not recommended
• And if approved?​
  
  • ​When SMC accepts a new medicine, NHS boards are expected to make it, or an equivalent SMC-accepted medicine, available.

Question 10

Give examples of controversial uses of the healthcare budget.

Answer 10

• Treatments to assist reproduction
• Cosmetic surgery
• Long-term nursing for the elderly
• Health education in schools
• Provision of traffic-calming measures
• Reversal of sterilisation
• Incentives:
  
  • New mothers paid to breastfeed
  • Incentives used in weight loss
  • Incentives used in smoking cesstion
• “Bribing patients is bad medicine. We decrease the autonomy of the patient and contaminate our relationship with them”.