Health Screening

Question 1

Why set priorities

Answer 1

Because of scarcity of resources
Demand outstrips supply
Difficult decisions have to be made

Question 2

What are the two forms of rationing

Answer 2

Explicit rationing and implicit rationing

Question 3

What is explicit rationing

Answer 3

Based on defined of entitlement
Explicit health rationing or priority setting is the institutional procedures for systematic allocations of resources within the healthcare system

Question 4

What is implicit rationing

Answer 4

Care is limited, but neither the decision nor the basis for those decisions are clearly expressed
Implicit rationing is the allocation of resources through individual clinical decisions without the criteria for those decisions being explicit

Question 5

What are the pros of explicit rationing

Answer 5

Transparent
Accountable
Opportunity for debate
More clearly evidence based
More opportunities for equity in the city making

Question 6

Cons for explicit rationing

Answer 6

Very complex
Heterogeneity of patient and illness
Patience and professional hostility
Impact on clinical freedom
Some evidence of patient distress

Question 7

Cost minimisation analysis

Answer 7

Outcome is assumed to be equivalent
Focus is on cost
Not often relevant as outcomes really equivalent

Question 8

Cost-effectiveness analysis

Answer 8

Used to compare drugs or interventions which have a common health outcome
Compared in terms of cost per unit
If cost are higher for one treatment or benefits or to need to calculate how much extra benefits is obtained for the extra cost

Question 9

Cost benefit analysis

Answer 9

All input and outputs valued in monetary terms
Can allow comparisons with interventions outside healthcare
Methodological difficulties
Payment is problematic

Question 10

Cost utility analysis

Answer 10

Particular type of cost effectiveness analysis
Cost utility analysis focuses on quality of health outcomes produced or foregone
Most frequently used measure is quality adjusted
Intervention can be compared in cost per QALYs

Question 11

Criticisms of QALYs

Answer 11

Controversy about the values they embody
Do not distribute there should be resources according to need but according to the benefits gain pay unit of cost
May disadvantage common condition
Technical problems with their calculations
May not embrace all dimensions of benefits
Do not assess impact on carers or families