ICM - Resources

Question 1

What is rationing in healthcare? Why is it important?

Answer 1

Rationing is the acknowledgement that the limited resources available cannot meet the needs of all those in the population. In healthcare this means that those resources are allocated to those most likely to benefit with the understanding that this will mean that some of these resources/services will not be available to some of the population.It is important because we have a constant challenge with budget/resources and demand:
- aging population
- multiple co-morbidities
- increasing technology and therapeutics vying for resources.
- rising public expectations

Question 2

What types of healthcare rationing are you aware of?

Answer 2

• Macro-level rationing - government level e.g. determining overall health budget.
• Meso-level rationing - regional bodies e.g. CCG
• Micro-level rationing - bedside decisions about likely benefit of resources with potential for pressure on those resources.

Question 3

Who should be admitted to Critical care?

Answer 3

In an ideal world all those that are likely to benefit from its resources.
However ICU is a high-cost finite resource and therefore some selection has to occur.
Overall the principle is to derive the most benefit from this resource (cost-effectiveness) in the most ethical way possible.
NHS England strategic aims for critical care are:
- prevent avoidable mortality from omission of critical care to those who would benefit
- Avoid triage by resources as opposed to triage by outcome. Patients should have access based on capacity to benefit.
- achieve equity of access.

Question 4

What methods of healthcare economic evaluation are you aware of?

Answer 4

• Cost-benefit analysis (superiority of outcome when costs are equivalent)
• Cost-minimisation analysis (superiority of cost when outcomes are equivalent e.g. generic prescribing)
• Cost-effectiveness analysis (difference in cost/difference in effect (ARR) = ICER; allows cross-comparison of interventions with same outcome measure)
• Cost-utility analysis (QALYs - allows comparison across interventions with different outcome measures).