HaDSoc Week 8 Flashcards
Why is it necessary to ration resources in healthcare?
Scarcity of resources - demand outstrips supply
Difficult decisions have to be made in order to sustain a publicly funded healthcare system
Planned expenditure for 2016/17 is 120.6 billion
By 2031 the number of over 75s is estimated to rise to 8.2m (currently 4.7 m)
60% of those aged over 65 have a long term condition
Increased incidence and prevalence of cancer
New drugs are expensive - e.g. Cancer therapies - broader range of people, less side effects - often dont cure but offer increased survival- also preventer drugs e.g. HIV
Resources could be used in many ways
What are the ethics regarding rationing?
Need to be clear and explicit about what we are trying to achieve and who benefits from the public expenditure
Describe the two types of rationing
Explicit rationing - based on defined rules of entitlement - who gets treatment, under what conditions - use of institutional procedures for the systematic allocation of resources in the healthcare system - decisions and reasons behind those decisions are explicit - technical processes - assessment of equity and efficiency - political processes - lay participation
Implicit rationing - care is limited, but neither the decisions nor the basis for those decisions are clearly expressed - allocation of resources without the reasons being explicit - can lead to inequities and discrimination, open to abuse, decisions based on perceptions of “social deservingness” instead of good evidence and clinical reasoning - doctors appear increasingly unwilling to do it although some still see merit in it given the complexity of medical care and individualised practise - more fine grained and sensitive way of doing things
What are the advantages and disadvantages of explicit rationing/priority-setting?
Advantages: Transparent and accountable in theory Opportunity for debate - media etc. More clearly evidence-based More opportunities for equity in decision making
Disadvantages:
Very complex
Heterogeneity of patients and illnesses - treats them homogenously
Patient and professional hostility
Impact on clinical freedom - if want to prescribe something but can under the NHS
Some evidence of patient distress
What is NICE?
National institute for health and care excellence
Set up to enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources
Provides guidance on whether treatments (new or existing) can be recommended for use in the NHS in England
In England they expect you to take their guidance into account but people also have the right to be involved in discussions and make informed decisions about their care
NICE is asked to appraise significant new drugs and devices to help make sure that effective and cost effective products are made available to patients quickly and to minimise variations in the availability of treatments
Once national guidance has been issued by NICE, it replaces local recommendations and promotes equal access for patients across the country
CCGs have started to put additional requirements for whether someone can have a treatment in place - in an effort to control their spending and thus protect their budget
NICE has particularly controversial role in relation to expensive treatments
If not approved, patients are effectively denied access to them (except for individual requests - exception not the norm)
If approved local NHS organisations may fund them (if clinically appropriate) - sometimes with adverse consequences for other priorities
What is health economics of value to doctors?
They are involved in decisions about resource allocation - on the NICE panel
Knowing about health economics helps them to contribute/learn from the evidence
Need to be able to explain to patients why they have been denied a treatment
What is meant by scarcity?
Need outstrips resources. Prioritisation is inevitable
What is meant by efficiency?
Getting the most out of limited resources
What is meant by equity?
The extent to which distribution of resources is fair
Each person with the same level of need receives the same care
What is meant by effectiveness?
The extent to which an intervention produces desired outcomes
What is meant by utility?
The value an individual places on a health state - does the clinical outcome have any value to the patient?
What is meant by opportunity cost?
Once you have used a resource in one way, you no longer have it to use in another way - can only spend the money once
The opportunity cost is the value of the next best alternative use of those resources
Cost is viewed as sacrifice rather than financial expenditure
Measured in benefits foregone
E.g. One course of IVF treatment has an opportunity cost of 1 heart bypass operation
What is technical efficiency ?
You are interested in the most efficient way of meeting a need e.g. Should antenatal care be community or hospital based?
What is allocative efficiency?
You are choosing between the many needs to be met e.g. Hip replacement or antenatal care
What is economic evaluation?
Comparison of resource implications and benefits of alternative ways of delivering healthcare
Can facilitate decisions so that they are more transparent and fair
Economic analysis compares the inputs (resources) and outputs (benefits and value attached to them) of alternative interventions - allows better decisions to be made about which interventions represent the best value for investment
