L16 Flashcards
What is rationing?
Priority setting/managing scarcity
Use a diagram to show how rationing by price works in a normal market?
See notes
Why is rationing in HC different? Show this on a diagram, and show/explain demand for this too?
In HC a supply of HC is rationed by the state
Demand increasing on diagram to show D for HC is always increasing overall due to: increasing expectations, ageing populations, and technological improvements
See notes
What is the economic approach to priority setting?
Use economic evaluation to recommend how HC can be rationed efficiently
What does the use of QALYs do?
Attempts to maximise the benefit to society from HC spending
Assumes (naively) that the preferred option is on that maximises health gain/£spent
Why do some say QALY’s are ‘fair’?
A QALY is a QALY regardless of who receives it; they ignore class, sex, ethnicity (and to some extent age)
What is the ‘threshold approach’ to priority setting?
Country sets a £x/QALY they are willing to pay; if below this amount, will fund, if above this amount, will not fund (see diagram)
4 criticisms of QALY-threshold approach to priority setting?
1) Fails to consider number of potential benefitters (1 person getting 1 QALY probs more important than 1000 getting 0.01 QALYs)
2) Doesn’t consider if a disease is self-inflicted (ie. smoking -> lung cancer vs. born with disability)
3) Insensitive to severity (0.2->0.3 for 1yr same value as 0.8->0.9, probably not true)
4) Insensitive to age IF say child and pensioner have 10yr terminal illness then same QALY value for both
What is equity in HC?
The ‘fairness’ of distribution of HC (not same as equality; equity considers the NEED of the patient)
2 problems with equity as a measure?
Difficult to measure
Many different concepts
What is vertical and horizontal equity?
Vertical equity = people with unequal needs accessing unequal treatment
Horizontal equity = people with equal needs have equal treatment
Observation often found in HC equity?
Often people with lower needs use relatively more HC than those with higher needs
What is NICE’s position on equity?
Do not only base decisions on benefit and cost, but also on other factors relating to fairest distribution of HC to society as a whole
If we were to ration on the basis of personal characteristics, which three could be considered?
1) Deserved? what have we done/not done in our lives?
2) Life cycle: age of patients
3) Hard-life
What are the two main concepts of ‘hard-life’ HC access?
1) Rawls maxi-min (focus on those worst off)
2) Double-jeopardy argument (do not give more hardship to those who already have had it)
