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Population and Social Science > L15- Resource allocation and health economics > Flashcards

L15- Resource allocation and health economics Flashcards

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1
Q

NHS is in crisis due to

A

budget cuts

- must make hard decisions with regards to where money is spent

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2
Q

priority setting describes

A

decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care

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3
Q

rationing describeds

A

the effect of those decisions on individual patients, that is, the extent to which patients receive less than the best possible treatment as a result

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4
Q

why set priorities

A
  • Resources are scarce and could be used in many ways
  • Demand outweighs supply
  • Difficult decisions have to be made
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5
Q

demand driven by

A

changing demographics

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6
Q

changing demographics

A
  • Number of over 75s is rising
  • 60% of over 65s have LTC
  • Increased incidence and prevalence of cancer
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7
Q

ethics

A

need to be clear and explicit about what we are trying to achieve and who benefits from
public expenditure

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8
Q

two forms of rationing

A

explicit rationing

implicit rationing

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9
Q

explicit rationing

A

the use of institutional procedures for the systematic allocation of resources within health care system

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10
Q

with explicit rationing the decisions are made by an

A

administrative authority as to the amounts and types of resources to be made available, eligible populations

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11
Q

simple explicit rationing

A

specific rules for allocations

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12
Q

positives of explicit rationing

A
  1. transparent
  2. accountable
  3. opportunity for debate
  4. evidence based
  5. more opportunities for equity in decision-making
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13
Q

negative of explicit rationing

A
  1. very complex
  2. heterogeneity of patients and illnesses
  3. patient and professional hostility
  4. impact on clinical freedom
  5. patient distress
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14
Q

implicit rationing

A

is the allocation of resources through individual clinical decisions without the criteria for those decisions being explicit

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15
Q

with implicit rationing discretionary decisions are made by

A

managers, professionals, and other health personnel functioning within a fixed budgetary allowance

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16
Q

weaknesses of implicit rationing

A
  • Can lead to inequities and discrimination
  • Open to abuse
  • Decisions based on perceptions of social deservingness
  • Doctor appear increasingly unwilling to do it
    o e.g. Dr deciding not to give treatment of someone they don’t think worthy e.g. a criminal
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17
Q

NICE stands for

A

national institute of health and care excellence

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18
Q

NICE was set up to

A

to enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment relative to alternative uses of resources

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19
Q

NICE provides guidance on

A

whether treatments (new or existing) can be recommended for use in the NHS in England

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20
Q

NICE is asked to

A

• NICE is asked to appraise significant new drugs and devices to help make sure the effective and cost effective products are made available to patients quickly and to minimise variations in the availability of treatments

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21
Q

people dont like NICE because

A
  • controversial role inr elation to expensive treatments
  • ## if not approved patients are effectively denied access to them
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22
Q

if drug is approved by NICE

A

NHS mist fund them- with adverse consequences for other priorities

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23
Q

scaricity

A

need outstrips resources. Prioritisation is inevitable

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24
Q

efficiency

A

getting the most out of limited resources

25
Q

equity

A

the extent to which distribution of resources is fair

26
Q

effectiveness

A

the extent to which an intervention produces desired outcomes

27
Q

utility

A

the value an individual places on health state

28
Q

opportunity cost

A

once you have used a resource in one way, you no longer have it to use in another way

29
Q

two types of efficiency

A

technical and allocative

30
Q

technical efficiency

A

Interested in the most efficient way of meeting a need (e.g. should antenatal care be community or hospital based?)

31
Q

allocative efficiency

A

Choosing between the many needs to be met ( e.g. fund hip replacement or neonatal care?)

32
Q

opportunity cost explained

A

o When deciding to spend resources on a new treatment, those resources cannot now be used on other treatments

33
Q

opportunity cost of the new treatment is the . value of the

A

next best alternative sue of those resoruces

34
Q

cost is viewed as

A

sacrifice rather than financial expenditure

35
Q

opportunity cost measured in

A

benefits forgone e.g. cost of IVF

36
Q

opportunity cost of IVF

A

One course of IVF treatment is £2700. Three courses of IVF (£8100) increases probability of pregnancy by 30%.

Good value? Not a life threatening condition
With £8100 could also fund:
-	Cochlear implant
-	1 heart bypass operation
-	11 cataract removals
-	150 MMR vaccinations
37
Q

economic evluation

A

Comparison of resource implications and benefits of alternative ways of delivering healthcare.

 Used to make funding decisions more transparent and fair

38
Q

how to measure cost

A

Identify, quantify and value resourced needed

  1. cost fo the healthcare services
  2. cost of patients time
  3. cost associated with care-giving
  4. other costs associated with illness
  5. economic costs borne by employers, other employees and the rest of society
39
Q

how do you measure benefits?

A

harder to measure- improved health hard to value

  1. impact on health status
  2. savings in other healthcare resources
  3. improved productivity
40
Q

types of evaluation which compare cost and benefit

A
  1. cost minimisation analysis
  2. cost effectiveness analysis
  3. cost benefit anlysis
  4. cost utility analysis
41
Q

cost benefits analysis

A

all inputs and outputs valued in monetary terms

  • willingness to pay often used
  • can allow comparisons-with interventions outside healthcare
42
Q

weakness of cost benefit analysis

A

methodological difficulties e..g putting monetary value on non-monetary benefits such as lives saved

43
Q

cost minimisation analysis

A

outcomes assumed to be equivalent
- focus on costs (only inputs)

e. g. all prostheses for hip replacement improve mobility equally
- choose the cheapest one

44
Q

weakness of cost minimisation analysis

A

not often relevant as outcomes rarely equivalent

45
Q

cost effectiveness analysis

A

used to compare drugs or interventions which have a common health outcome e.g. reduction in blood pressure

compared in terms of cost per unit outcome
e.g. cost per reduction of 5mm/Hg

46
Q

with cost analysis if costs are higher for one treatment, but benefits are too, need to calculate how much extra

A

benefit is obtained for the extra cost

is extra benefit worth extra cost

47
Q

cost-utility analysis

A

particular type of effectiveness analysis

48
Q

cost utility analysis focusses on

A

quality of health outcome produced or foregone

uses QALYs

intervention can be compared in costs per QALY terms

49
Q

Quality adjusted life years

A

a measure of effectiveness of a treatment s

50
Q

QALY incorporates

A

quality and quantity of life gained§ by a treatment

51
Q

1 year of perfect health

A

1 QALY

52
Q

2 years of 50% QOL

A

1 QALY

53
Q

Example: man is diagnosed with cancer

A

Told he has 1 year to live if he does not have treatment
• His quality of life, without treatment, will be 0.8 of perfect
health and he will then die quickly
• Without treatment = 0.8 QALYs
• If he receives treatment he will live for 4 years, but his QoL will be 0.2 of perfect health
• With treatment = 0.8 QALYs (4 x 0.2)
 No gain in QALYS associated with treatment

54
Q

alternatives to QALYs

A
  • Health Year Equivalents (HYEs)
  • Save-young-life equivalents (SAVE)
  • Disability adjusted life years (DALYs)
55
Q

NICE use

A

QALY

56
Q

NICE and cost per QALY

A

below £20k per QALy will normally be approved

57
Q
  • £20-£30k per QALY
A

judgements will take account of:
o Degree of uncertainty
o If change in HRQoL is adequately captured in the QALY
o Innovation that adds demonstrable and distinctive benefits not captured in the QALY

58
Q

above £30k

A

need an increasingly stronger case

59
Q

criticism of QALY

A
  • Controversy about the values they embody
  • Do not distribute resources according to need, but according to the benefits gained per unit of cost
  • May disadvantage common conditions
  • Technical problems with their calculations
  • QALYs may not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative
  • QALYs do not assess impact on carers or family

Population and Social Science (14 decks)

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