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Semester 4 > HaDSoc Session 8 > Flashcards

HaDSoc Session 8 Flashcards

1
Q

What is explicit rationing based on?

A

Defined rules of entitlement/institutional procedures for systematic allocation

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2
Q

What is implicit rationing based on?

A

Individual clinical decisions without explicit criteria

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3
Q

Why is healthcare expenditure rising worldwide?

A

Changing demography, technology, consumerism, increasing demand

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4
Q

What are the problems associated with implicit rationing?

A

Inequities, discrimination, can be abused, social deservingness

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5
Q

What are the benefits associated with implicit rationing?

A

More sensitive to complexity of medical decisions, needs and preferences of individual pts

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6
Q

What are the advantages of explicit rationing?

A

Transparent, accountable, opportunity for debate, more clearly evidence-based, mor opportunities for equity

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7
Q

What are the disadvantages of explicit rationing?

A

Very complex, heterogeneity of pts and illnesses no accounted for, pt and professional hostility, impact on clinical freedom, some evidence of pt distress when denied Tx

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8
Q

What are the 5 levels of allocation?

A

Allocation to NHS vs other sectors; across specialities; specific interventions; interventions between pts of same group; investment for each initiated intervention

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9
Q

What is the purpose of NICE?

A

Evidence of clinical cost effectiveness integrated to inform a national judgement on the value of a Tx relative to alternative use of resources

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10
Q

Why does NICE guidance replace local recommendations?

A

Provide equal access across the country so effective and cost-effective interventions are made available quickly

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11
Q

What happens if an intervention receives NICE approval?

A

Local NHS organisations must fund if clinically appropriate, thus removing funding from elsewhere

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12
Q

What happens if NICE does not approve an intervention?

A

Pts are effectively denied access except for individual requests

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13
Q

What is the purpose of health economics?

A

Provide info to assist allocation of scarce resources to maximise social benefits

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14
Q

What is the need for economic assessment?

A

Bring reality of fixed NHS resources to public attention, expose opportunity costs, enable consistency in investment, direct innovation, help make principles of allocation explicit, help Dr’s to understand/contribute to evidence

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15
Q

What are the basic concepts in health economics?

A

Scarcity, efficiency, equity, effectiveness, utility, opportunity cost

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16
Q

What are the 5 levels of allocation?

A

Allocation to NHS vs other sectors; across specialities; specific interventions; interventions between pts of same group; investment for each initiated intervention

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17
Q

What is the purpose of NICE?

A

Evidence of clinical cost effectiveness integrated to inform a national judgement on the value of a Tx relative to alternative use of resources

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18
Q

Why does NICE guidance replace local recommendations?

A

Provide equal access across the country so effective and cost-effective interventions are made available quickly

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19
Q

What happens if an intervention receives NICE approval?

A

Local NHS organisations must fund if clinically appropriate, thus removing funding from elsewhere

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20
Q

What happens if NICE does not approve an intervention?

A

Pts are effectively denied access except for individual requests

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21
Q

What is the purpose of health economics?

A

Provide info to assist allocation of scarce resources to maximise social benefits

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22
Q

What is the need for economic assessment?

A

Bring reality of fixed NHS resources to public attention, expose opportunity costs, enable consistency in investment, direct innovation, help make principles of allocation explicit, help Dr’s to understand/contribute to evidence

23
Q

What are the basic concepts in health economics?

A

Scarcity, efficiency, equity, effectiveness, utility, opportunity cost

24
Q

Describe the concept of scarcity in healthcare economics.

A

Need outstrips resources therefore prioritisation is inevitable

25
Q

What is technical efficiency?

A

Most efficient way of meeting a need

26
Q

What is allocative efficiency?

A

Choosing between many needs to be met for the population

27
Q

What is utility in healthcare economics?

A

Value an individual places on their health state

28
Q

What is opportunity cost?

A

Value of next best use of resources measured in benefits foregone

29
Q

What is the aim of investigating opportunity cost?

A

From a limited budget want to find the most efficient mix of services generating the greatest aggregate benefit

30
Q

What are the implications of trying to find the greates aggregate benefit from a limited budget?

A

Ethical due to different conceptions of welfare

31
Q

What is economic evaluation of healthcare underpinned by?

A

Scarcity, efficiency, opportunity cost and utility

32
Q

What costs are considered in healthcare economics?

A

Healthcare services, pt’s time, care-giving, ilness, economic costs borne by employers and society

33
Q

What benefits are measured when using economic evaluation in healthcare?

A

Impact on health status, savings in other healthcare resources, increased productivity with sooner return to work

34
Q

What are the problems with economic evaluation of healthcare?

A

Assumptions built into approach may influence conclusion, some health benefits are not felt for some years

35
Q

How can problems associated with economic evaluation of healthcare be resolved?

A

Use of sensitivity analysis to check effects of assumptions. Discounting to take calculate present values of inputs and outcomes that accrue in the future

36
Q

What are the 4 types of economic evaluation of healthcare?

A

Cost minimisation analysis, cost effectiveness analysis, cost benefit analysis, cost utility analysis

37
Q

What is cost minimisation analysis?

A

Outcomes are equivalent (benefits all the same) so focus is on cost

38
Q

Why is cost minimisation analysis not often relevant?

A

Outcomes are rarely equivalent

39
Q

Give an example of cost minimisation analysis.

A

Improvements to mobility for different hip prostheses are equal so chose the cheapest

40
Q

What is cost effectiveness analysis?

A

Comparison of interventions that have a common health outcome in terms of cost per unit outcome

41
Q

What question does cost effectiveness analysis ask?

A

Is extra benefit worth extra cost?

42
Q

What is cost benefit analysis?

A

All opin outs and outputs are valued in monetary terms to allow comparison outside of healthcare

43
Q

What difficulties are seen in cost benefit analysis?

A

Methodological: putting monetary value on non-monetary benefits e.g. Willingness to pay

44
Q

What is cost utility analysis?

A

Focuses on quality of health outcomes produced or foregone most frequently by QALY

45
Q

What do QALYs combine to evaluate healthcare?

A

Quality and quantity of life

46
Q

What does 1 QALY equal?

A

1 year of perfect health/10 years of 0.1 QoL/2 years at 0.5 QoL/6 months at 1 QoL for 2 people

47
Q

What are the problems associated with the evidence used for QALYs to evaluate healthcare?

A

RCTs not perfect evidence, comparison Tx differ, length of follow-up implications, atypical pts and care, limited generalisability, sample size implications

48
Q

Name some alternatives to QALYs.

A

Health Year Equivalents (HYEs), Saved-Young-Life-Equivalents (SAVEs), Disability Adjusted Life Years (DALYs)

49
Q

What are the problems associated with NICE use of QALYs?

A

Resented by pts and pharma, CCGs prioritise NICE-approved interventions with unintended consequences to opportunity costs, political interference

50
Q

How do NICE use QALYs?

A

Technology appraisals of clinical and cost effectiveness with consultation involving identification of topics, scoping, assessment and appraisal

51
Q

How does the cost per QALY influence NICE approval?

A

£30k needs a strong case

52
Q

Who is involved in the NICE use of QALYs?

A

DoH, professionals, pts, carers, public, health technology assessment groups, committees

53
Q

What are the disadvantages associated with using QALYs to evaluate healthcare?

A

Values embodied, distribution of resources is not by need, may disadvantage common conditions, technical problems, data unrepresentative, impact on carers

54
Q

How is cost effectiveness calculated using QALYs?

A

Calculate QALYs with and without intervention. Subtract to find QALYs gained. Divide total cost (cost per annum times life expectancy) by QALYs gained

Semester 4 (33 decks)

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