L17 Flashcards
What was the pre-1999 approach to rationing?
Cabinet ministers decided budget, doctors decided which patients/treatments should get treatment
Explain the methods by which the pre-1999 system rationed implicitly?
Delays (ie. long waiting times)
Deterrents (difficulty in accessing HC, eg. travel distance)
Dilution (decrease in time given per consultation etc.)
Denial of treatment
What is the problem with implicit rationing?
Not clear why treatment isnt given, not officially acknowledged - could result in different patients being treated differently!
What is explicit rationing?
Clear criteria are provided for refusing/providing care
Practical issues with explicit rationing? (4 questions)
Who should set these criteria?
What criteria should be used?
Will they be followed?
How will they be set?
What do NICE do?
Provide guidance and advice to improve social care
What is NICE’s aim?
Make decision-making in HC SYSTEMATIC and EXPLICIT
What do NICE consider mostly when setting guidelines? (2)
Cost
Clinical effectiveness
When did NICE start? When did it change?
1999, 2005 and 2013 (see slide if needed)
4 main roles of NICE?
1) Guidelines (suitable HC services, health promotion)
2) Technology approval (recommendations on interventions and new/existing treatments)
3) Medical technology guidance
4) Diagnostic technology guidance
Examples of groups which NICE consult with?
Patients and carer corporations, HC professional representatives, NHS england, HC manufacturers, commentators (research groups, tech firms etc.)
How does NICE determine whether it recommends interventions etc.? Draw diagram for this!!!
Uses societies WTP for one additional QALY to find the threshold for funding
Explain 3 different regions which an intervention may fall under in the UK, and how NICE would recommend based on it?
ICER below £20K/QALY - usually recommend (unless poor evidence)
ICER 20-30K/QALY - will use judgement (eg. equity, innovativeness of technology, certainty of ICER (was QofL measured correctly?))
ICER 30K/QALY plus - usually reject, unless strong arguments for the treatment
How do NICE view end-of-life scenarios?
They provide additional guidance for these types of treatments; society has a greater WTP if is last few months/yrs of ones life
4 of NICE’s achievements?
1) Transparency (all info. on website tf appraisal process is clear and fair)
2) Inclusive: Stakeholders strongly included in DMing process
3) Systematic …use of best available evidence
4) Respected: well respected body of professionals
TIRS
4 issues with NICE?
1) National (rather than regional) view tf may hurt some areas and help others (one-size fits all argument)
2) Threshold (some argue too high/low)
3) Judgement (consideration of ‘wider issues’ ie. judgement stage, not clearly taken into account!)
4) Negative reaction when drugs etc. are sometimes rejected
Learn
Bariatric case study (important!!!)
What are the four primary categories are outlined in NICE’s cost perspective?
1) Primary: GP, nurse visits etc.
2) Secondary: A&E attendance, inpatient stays, surgery, tests etc.
3) Social care: eg. nursing homes, home help
4) Interventions: Medications and intervention costs etc
What two other costs do they consider?
Patient costs: transport, OTC medications, paid/informal care etc.
Indirect costs: time off work, reduced productivity etc (rarely included in UK analyses, other such as Netherland they are)
2 problems with NICE focusing primarily on their 4 cost categories?
1) Public health interventions have much wider range of Bs and Cs
2) Some treatments have much wider implications (eg. treatment for heroin users)
