Health economics/systems Flashcards
Features of tax-funded healthcare system
Budget allocated from general taxation
Everyone contributes - direct + indirect taxation
Universal coverage
Cost containment
Reduced choice
Moral hazard - increased demand when sick and reduced incentive when healthy
Features of social insurance funded healthcare system
Money earmarked for healthcare from employment tax - employer + employee contribs
More transparency
Sensitivity to workforce changes
Difficulty covering vulnerable gourps (e.g. homeless)
Equal care + cost containment
Features of private insurance healthcare
Individual opts to have insurance - individually contributes
Higher healthcare cost + variation in quality based on ability to pay
More choice and ?higher quality
Methods of paying doctors
Capitation - fixed payment per patient
Salaries - fixed monthly wage
Fee-for-service - payment per procedure/consultation (USA)
Choice of comparator in health economic evaluations
Treatment most likely to be replaced by what you are considering
May include multiple comparators
Difficulties: may have changed since RCTs, RCTs may be in different countries/populations w/ different comparator
Cost-minimisation evaluation
Aim for equal safety and effectiveness for minimal cost
Cost-effectiveness evaluation
Measure cost against natural units (e.g. syptom-free days, life years gained)
Easy to measure but difficult to compare across units
Cost-utility evaluation
Measure against QALYs
Cost-benefit evaluation
Monetary valuation of health benefit
Principle of QALYs
Additional years of life weighted based on ‘utility’ from 0 to 1
How much would people be willing to sacrifice for a given healthcare state
EuroQoI common measure but has limitations
Idea is that 1 QALY is equal across conditions, populations, etc…
Choice of costs in economic evaluations in healthcare
Consider opportunity cost not just accounting cost - what is lost from spending on this treatment vs another
Perspective: Health costs but also costs to society (employment), indirect (e.g. carers), government, etc…
Elements of cost in health economic evaluation
Unit cost: e.g. cost per night in hospital; from reference costs, BNF, trust accounting
Resource use: e.g. number of nights in hospital, from clinical trials, hospital records, patient questionairres
Incremental cost-effectiveness ratio calculation
(Cost 1 - Cost 2) / (Effectiveness 1 - Effectiveness 2)
Gives increased cost per QALY
Role of NICE
Provides guidelines for diagnosis, management, treatment, etc… based on best-available evidence
Includes cost-effectiveness analysis
Standard against which providers are judged
Technology appraisals provides statutory requirement for CCGs to fund within 3 months
Role of NHS England
Commisioning of specialist services (e.g. transplants) at a national level
Oversee the functioning of CCGs
Develop commisioning guidance, refernce standards, contracts
