Lecture 2: The Cost of Health Care, the Cost-Effectiveness of Technologies, Engineering 101 Flashcards
What metrics go into a HTA?
Efficacy/Effectiveness, Performance of diagnostics,
Cost
TA: Litteneberg Model
- Biological Plausibility
- Technical Feasibility
- Clinical Trials
- Patient Outcomes
- Societal Outcomes
Biological Plausibility
Does the science support the technology?
Technical Feasibility
Can we safely and reliably deliver the technology to the patients who need it?
Clinical Trials
Do randomized clinical trials comparing the new technology to current standards show a benefit?
Patient Outcomes
Are patients better off with the new technology?
Societal Outcomes
What are the costs and ethical implication to society?
Why have US Costs Increased?
- Aging population
- Prescription drugs
- Administrative costs 4. Shift in type of providers
- Use of technology
QALY (Quality Adjusted Life Year)
a measure of disease burden, including both the quality and the quantity of life lived. It is used in assessing the value for money of a medical intervention.
How can technology drive costs down?
- Cost reductions through increased outpatient procedures
- Longer productive life span
- Biotech for disease with high DALY
Difficulties in Developing World
- Necessary technology does not exist
- Technology exists but is not accessible
- Accessible technology is not adopted
Engineering Design Method
- Identify a need
- Define the problem
- Gather information
- Develop solutions
- Evaluate solutions
- Communicate results
Incremental Cost-effectiveness Ratio (ICER)
Difference in cost/change in QALY = $ per QALY gained
What are the problems and solutions for technology not existing in developing countries?
- Funding issue
- insufficient funding devoted to develop necessary technologies
- Solutions? decrease cost to developer/increase potential reward for developer - Scientific Issues
- Scientific breakthrough does not exit
- Solution? Increase funding
What are the problems and solutions for technology not being accessible in developing countries?
- Cost
- cost too high, donations - Distribution
- Inadequate human resources
- Unreliable energy supply
- Design for developing world
What are frugal technologies?
“Good enough” products that meet the basic need but at a low cost. They often look inferior, provide limited functionality, made of simpler cheaper materials.
What are the problems and solutions for technology not being adopted in developing countries?
- Cultural resistance
- technology conflicts with tradition - Human inertia
- reluctance to change practice
Health Systems
The human resources, physical infrastructure, health care technologies, and economic resources devoted to improving the health of the population.
What are the functions of Health Systems
- Generate human resources, physical infrastructure, and knowledge to provide health care
- Provide health care services
- Raise and pool economic resources
- Provide stewardship for the healthcare system
What are the four basic models of health care?
- Beveridge Model
- Bismark Model
- National Health Insurance Model
- Out of Pocket Model
What are the Global Initiatives on Health Technologies?
To establish a framework and identify and adapt innovative technologies
Beveridge Model
Health care provided and financed by the government. Hospitals and clinics owned by government. Government controls what doctors can do and what they can charge.
Bismarck Model
Insurance system financed by employers and employees through payroll deduction. Insurance must cover everybody and no profit is made.
National Health Insurance Model
Uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into.
Out-of-Pocket Model
You pay out-of-pocket “the rich get medical care; the poor stay sick and die”
