eerste tentamen Flashcards
rationing
to limit the beneficial health care an individual desires by any means price or non price, direct or indirect, explicit or implicit
hard rationing
it is not allowed to obtain health care outside the public system for example through own payments, private clinics
soft rationing
it is allowed to obtain health care outside the public system
why does implicit rationing at the national level sometimes lead to explicit rationing at lower levels?
if the explicit choices about whom to treat and whom not are not answered at the higher level, then at the lower levels explicit rationing in some forms become inevitable
implicit rationing
sets limits tot resources but does not indicate how the resources should be allocated
explicit rationing
sets limits to the resources available in combination with choices on how the resources should be allocated.
Making explictly clear who gets what, when and how
why is rationing health care inevitable?
scarity is core. there are limited resources but unlimited desires, therefore never enough resources to fulfil human wants and needs.
scarcity
There are never enough resources to fulfil all human wants and needs
opportunity costs
An important input in making choices.
If you chose one option, you forego another use of resources. The BEST alternative sacrificed are the opportunity costs.
advantages of waiting lists
- reduces need to use other rationing mechanisms
- waiting time functions as a price, longer waiting indices lower demand
- in principle the waiting lists are equal to rich and poor
- unnecessary care is restricted
- existing waiting times can reduce the flow of referrals
- waiting lists can help to use available capacity optimally
disadvantages waiting times
- loss of quality of life during waiting
- health state may worsen during waiting time
- recovery time may increase with waiting time
- treatment may sometimes be less succesful after waiting times
- higher medical costs due to worse cases and lower succes rates
- uncertainty among patients about when they will be treated
- dissatisfaction in society when waiting times are perceived as too high
- costs in other economic sectors due to absence of waiting employees
- higher risk of becoming permantly disabled when waiting keeps you away from work for longer period
- differences in waiting times between countries way induce cross-border care
explain why reducing waiting times is difficult, even when hospital supply is effectively increased
If waiting time goes down, price decreases and demand goes up. The demand goes up faster than the waiting times reduces. GP reduce the referrals when waiting times are high.
explain how the introduction of maximum waiting time guarantees may result in suboptimal outcomes in terms of both the efficiency and equity objectives of a healthcare systems
maximum waiting time guarentee leads to the fact that the patient who are almost at the maximum waiting time receive the treatment sooner than beginning patients. When a patient waits longer than the maximum waiting time, there is a fine.
There is now a incentive to avoid people waiting longer than the agreed maximum waiting time. This means people close to the maximum time will prioritized at the expensive of other people who have a higher medical need. The average waiting time for people with a higher medical need goes up. This is not efficient, health is lost due to reprioritization.
absolute shortfall
disease related health loss without treatment
proportional shortfall
proportion of otherwise lived health lost
absolut shortfall : remaining health expectancy without disease
incremental cost effectiveness ratio
difference in cost : difference in qalys
tabel voor cost effectiveness
proportional shortfall: 0 tot 0,1 -> €0 per qaly
proportional shortfall: 0,11 tot 0,4 ->
€ 20 000 per qaly
proportional shortfall: 0,41 tot 0,7 -> €50 000 per qaly
proportional shortfall: 0,71 tot 1 -> €80 000 per qaly
Dismal science
Core assumption: desires are infinite, but resources are limited
- scarcity
- rationing inevitable
Market failure due to
Uncertainty and consequences of insurance
Information asymmetry
Existence of externalities
Why is rationing in health care such an issue?
- Care is a special good
- Central to human capabilities
- Strong feeling of solidarity
- Many countries health care is free
- Setting limits to access seen as indefensible
Why ration?
Opportunity costs in outside health care, but also inside health care
Inconsistent triad (Weale 1998)
The three basic wishes for health care cant be achieved at the same time. The three wishes are comprehensive, high-quality care for all citizens.
Four criteria for the basic benefits package (ZiN)
- Necessity
- Effectiveness
- Cost-effectiveness
- Feasibility
Reimbursement model
Premium from consumer to insurer.
Reimbursement from insurer to consumer
Provider payment from consumer to provider
