Keuzevak - Rationing Healthcare Flashcards
Rationing definition of Breyer
To limit the beneficial health care an individual desires by any means - price or non price, direct of indirect, explicit or implicit
- Limit beneficial healthcare
- price or non price;
- direct or indirect; direct (have certain criteria for treatment) indirect; limited resources such as doctors and waiting lines
- Explicit or implicit; explicit different things not included, implicit natural contraints
Other view of rationing definition - Maynard 1999
Rationing takes place when an individual is deprived of care which is of benefit (in terms of improving health status, or the length and quality of life) and which is desired by the patient
- More focus on the deprivation
- Broad benefit
Why rationing is neccesary
- healthcare spending; Large part of GDP, can not continue
- Life expectancy; longer living and requiring more resources, but limited, to whom we give them?
- World wide worries; waiting, copayments, not all treaments covered in collective insurance
- Culture; differences in priority in healthcare; transparency or solidarity
Scarcity
People want always more than the resources allow us to satisfy us all, lead to choice
- In healthcare; increasing spending
Difficult in how to limit consumption of health care and on what basis; waiting times Individual cases
economics concerned with
Efficient allocation of scarce resources over alternative uses (opportunity costs) and equity implications
Opportunity costs
The worth of the not chosen alternative
- Inside healthcare; more means something less for other patients
- outside healthcare; less education, less infrastructure etc
Equity
Fair distribution of resources to those who need it the most
Efficiency
Maximizing wellfare (hapiness) given a budget
Equity and efficiency
Go hand in hand and can not be solved independently
Utility is gained when:
- Utility is gained by buying and consuming goods at a price at or below what they are willing to pay from profit-maximizing firms without market power selling at a price they are willing to accept (equal to marginal costs)
Optimality in markets
- Individuals maximize own utility (best judges welfare)
- Perfect knowledge about price and characteristics
- Income distribution determines purchasing power
2 ways value of good
- Determined by income (value less because you have less)
- Determined by preferences
Why healthcare not an optimal market
- Uncertainty and consequences of insurance (moral hazard)
- Information assymetry; credance good
- Existance of externalities; Market doenst reflect the true societal costs –> covid, must take into account more external costs
Equity and efficiency balance; allocation and rationing job of the government
Price and non price rationing (breyer 2013)
- Decide if you consume on price or not; price rationing
- Decide on other things if you consume (waiting times or professional judgement); non price rationing)
Government regulation; not all price mechanisms but also priority, to allocation of healthcare
Ethical argument against health economics
- We must do anaything possible for the patient no matter what the cost, because health is more worth than money
But; resource constraint system cost means sacrifice
In this case the value of benefits foregone by the person who did not get treated
- Consider what we could have done with the spending
First lesson of economics
First lesson of politics
- There is scarcity
- Disregard the first lesson of economics
Tension between what we can do and what is ideal
- We ration because of opportunity costs; the same resources can produce more health/wellbeing elsewhere
Inconsistent triad of Weale 1998
Basic healthcare principles
- Comprehensive
- High quality
- to all citizens
Given scarcity not all wishes at the same time; must face oppertunity costs when investing in health
- Inside healthcare
- Outside healthcare
Breyer need or benefit is related to
- An immediate danger or life
- The risk of a severe and lasting health impariment
- Any even only temporary deterioration of health
Not a dichotomous variable, but continuous; context dependent if it is of benefit for society or a person
rationing aspects
Societal level decision
Not only cost containment also what is delivered
priority setting
Price vs non price rationing
- Price rationing; allocation of scarces resources through price mechanisms
- Non price rationing; allocation of limited resources below market price; free of charge
Non price rationing means also you leave it out of the system and not in BBP, up to private market
primary vs secondary rationing
primary rationing; how much budget to spent on healthcare (direct and indirect) and how to determine (what contributes more to societal level)
Secondary rationing; budget is there, how to use it (eg. priorization, waiting lists)
- Also natural scaricty resources such as transplantable organs
Narrow rationing
Non price rationing; no coverage in BBP leave it up to market resulting in private market and price rationing
implicit vs explicit rationing
Implicit; a budget and limits to resources, but no procedures on how to spend it
- Cost budget and allocate it
- choices left to stakeholders in system (bedside rationing;)
Explicit; sets limits to resources in combination with how choices should be allocated
- limiting BBP on criteria
- Breast cancer criteria for treatment
- Explicit who gets what and what not
implicit pro and cons
Cons
- Different outcomes at lower level decision makers; other choices (breastcancer)
- doubt if it contributes to outcomes
- Choices left to lower levels
Pro
- Discretionair room for stakeholders to spend (look at every patient)
- Use own expertise on how to make choices- provider autonomy
- Reduces public resistance; as there are no procedures (no rules so no harm)