Healthcare Resources (Renal Dialysis)

Question 1

Are the costs of healthcare increasing or decreasing ?

Answer 1

Increasing (partly due to aging population)

Question 2

Does the UK achieve better or worse outcomes than its close competitors ? Why ?

Answer 2

Worse, but also cheaper prices so in terms of outcome per cost, much better thanks to strong primary care (strong primary care makes it much more cost effective)

Question 3

Give examples of NHS targets ? How many are there ? How many of those were achieved ?

Answer 3

8 targets total including:

• 18 weeks referral-treatment
• 4 hour A/E

Only 1 achieved,
-Waiting time for treatment of substance abuse

Question 4

True or false: different health boards have different achievement of NHS targets.

Answer 4

True, different numbers of targets achieved for different boards

Question 5

Identify the main areas in which you would spend NHS budget.

Answer 5

• Public health (invest to save, e.g. smoking cessation)

- Primary care

Question 6

Distinguish between equity and equality.

Answer 6

Equity = Fairness so Inequity = Unfair or Unjust

Equality = Sameness so Inequality = Unequal

Question 7

To what extent is equity of health achievable ? Equality of healthcare ?

Answer 7

Many factors influence health, meaning that complete equity of health is never achievable: equalising healthcare can be considered as paternalistic.

Question 8

Distinguish between vertical and horizontal equity.

Answer 8

Aristotle’s theory of distributive justice makes the distinction between vertical and horizontal equity:

• horizontal equity refers to equity between people with the same healthcare needs
• vertical equity refers to those with unequal needs who should receive different or unequal health care

Question 9

Give an example of inequity in healthcare.

Answer 9

Everyone has GP (total equality), but demand upon practice is different depending on community in which they work (equity problem, between different areas)

Majority of public would not give more budget for substance misuse, which reflects an equity issue (unfair)

Large difference in rates of urodynamic testing between different health boards.

Question 10

What’s a Clinical Commissioning Groups (CCGs) ?

Answer 10

Clinical Commissioning Groups (CCGs) commission most of the hospital and community NHS services in the local areas for which they are responsible.
Commissioning involves deciding what services are needed for diverse local populations, and ensuring that they are provided (e.g. in one area, CCG decides in IVF only get one try, in another get two to three tries)

Question 11

State the inverse care law.

Answer 11

The inverse care law states that the availability of good medical care
tends to vary inversely with the need for it in the population served

Question 12

How can we measure health inequalities ?

Answer 12

Measuring health inequalities can be achieved by:

• Measuring health need
• Measuring access to health care
• Measuring quality of health care

Question 13

Identify the main types of need which exist.

Answer 13

1) Felt = Individual perceptions of variations from normal health
2) Expressed = Individual seeks help to overcome variation from normal health (demand)
3) Normative = Professional defines interventions appropriate for the expressed need
4) Comparative = Comparisons between needs for severity, size, range of interventions, cost

Question 14

Describe GPs at the deep end.

Answer 14

GPs working in most deprives communities in Scotland
Whereas GPs in nice communities are coping nicely, if in bad areas,
they have too much morbidity (example of equality not meaning equity. May be equal but not equitable)

Question 15

Identify possible reasons for the variations in rates of urodynamic testing.

Answer 15

A. Population demographics (v elderly population, many more urinary problems)
B. Large spinal injury unit in
the area (where urodynamic testing is included)
C. Number of staff with skills
to undertake tests 
D. Lack of guidelines for when
tests should be carried out
E. Patient reluctance to seek
help for incontinence
F. Differences in
commissioning

Question 16

Describe the broad strategic approach to setting healthcare priorities.

Answer 16

• Budget, Demand, Price and Cost (in terms of cost, investing may allow us to save money, e.g. investing in primary education against drugs and alcohol reduce future secondary care interventions for those)
• Equality
• Equity (e.g. higher than average drug-related problems, equity would push you to to spend more on that to make it fair)
• Need

Question 17

Identify the main examples of cost pressures upon health boards.

Answer 17

Cost pressures may include:
• increased demand for services from a growing, ageing population
• increasing staff costs, in particular spending on temporary staff
• rising spending on drugs.

Question 18

Give an example of intervention to avoid alcohol abuse.

Answer 18

Education in schools about alcohol, drugs

Question 19

Describe the model of health care responsiveness and access to healthcare.

Answer 19

• Step 1: Approaches health service (do people know enough about their health to seek help + are they able to approach people, perhaps not due to little knowledge about entitlement to service)
• Step 2: Receives a service (do they show up, perhaps not due to limited knowledge of how the service works)
• Step 3: Service is responsive to needs (e.g. assessment, treatment doesn’t work, do we follow yo up, do we test what’s happening, do we ensure outcomes you get are appropriate ? Perhaps not, because services don’t tailer what they do to individuals patients’ learning needs)
• Step 4: Fully engage with providers/fully understands own health ends (genuine partnership formed with clinician? Perhaps not, because providers unaware that patients are not able to put knowledge into practice, leading to frustration and lack of trust)

Fewer people reach those last levels (most likely to be those with higher health literacy and higher socioeconomic status, which creates inequity. Health literacy is therefore an equity issue.