Intro To Resource Alloc Flashcards
LO2: expl inevitabil of rationing in HC systems.
-dem outstrips supply= set priorities. Diffic decisions.
-unavoidable- rap advs in medicine, NHS cant pay for ev new tx. Competing demands.
No country can keep up- ageing demography so LT conds and CA, technology, consumerism, dem always greater.
- 1948 gross expend 437m, 2015 113bn.
-new drugs not cure just incr surv.
-ethics- need to be clear and explicit about what trying to achieve and who benefs from public expend.
LO3: desc a range of approaches to resource alloc in HC.
-2 forms of rationing:
- IMPLICIT: care is lim but decis and basis of decis NOT clearly expressed.
Alloc resource through indiv clinic decis w/o explicit criteria.
Used lot by NHS pre 1990. Clinicians decis within overall budget constraint. Pts believed care off on basis of clinic need.
Can= inequity and discrim. Open to abuse. Decis based on percep of soc deservedness. Doctors incr unwilling.
But good as sensit to complexity of decis and personal and cult prefs of pts.
- EXPLICIT:
Based on defined rules of entitlement.
Explicit HC rationing or priority setting is use of instit procedures for systematic alloc of resources in HC sys. Clear reasoning.
Technical proc eg assessm of efficiency and equity.
Political proc eg lay particip.
Advs: transpar, accountable. Opp for debate. Ev based. More opps for equity.
Disadvs: complex. Heterogeneity of pt and illness. Pt and profess hostility. Impact on clinical freedom. Some ev of pt distress.
- levels of rationing:
How much to NHS and then across diff sectors. How much for specif intervens. How alloc intervens btw pts in same grp. How much invest in each pt once interven initiated. 114 bn.
-NICE:
Enable ev of clinic and cost effec to be integ to inform nat judgem on val of tx’s rel to alt use of resource. Recomms for NHS england.
Appraise sig new drugs and devices so cost effec prods avail fast to minim variat in tx. Nat guidance by NICE repls local recomm. Equal acc x country.
For expensive tx not approved, pts are denied access excep for indiv req. if approved then loc NHS orgs must fund them with conseqs for other priorities.
LO1: disc impact of scarce resources on work of doctors.
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