Lecture 6A Flashcards
Why do we need to set priorities?
Demand outstrips supply
Increasing technology is expensive
Young people believe healthcare has the answer to everything
What is the ethical consideration of priority setting?
Need to be clear and explicit about what we are trying to achieve and who benefits from public expenditure. Any decisions made need to be justifiable
Explicit vs implicit rationing?
Explicit is based on defined rules of entitlement normally from governing bodies
Implicit rationing is allocation of resources through individual clinical decisions without the criteria for those decisions bing explicit
Problems with implicit rationing?
Can lead to inequalities
Open to abuse
Doctors often unwilling to do it
Decisions based on perceptions of “social deservingness”
Problems with explicit rationing?
It’s complex
Heterogeneity of patients and illnesses
Impact on clinical freedom
Good in that it is more clearly evidence based, is transparent and accountable and more opportunity for debate
What is NICE?
National institute for health and care excellence. Provides guidance on treatments and their cost effectiveness
Problem with NICE?
They can produce guidelines on a treatment but that does not mean it can be afforded.
What are the basic concepts of health economics?
Scarcity- prioritisation used as need outstrips resources
Efficiency- getting most from limited resources
Equity- fair distribution
Effectiveness
Utility- value individual places on health state
Opportunity cost-
Opportunity cost?
Measured by benefit lost as opposed to benefit gained
Technical efficiency vs allocative efficiency?
Technical refers to most efficient way of meeting a need eg treatment hospital or community based
Allocative choosing between many needs to be met, eg fund hip replacements or neonatal care
How are benefits measured?
Impact on health status
Improved productivity
Savings in other healthcare resources
What are the four methods used to compare cost and benefit?
Cost minimisation analysis
Cost effectiveness analysis
Cost utility analysis
Cost benefit analysis
Cost minimisation analysis?
Outcomes assumed to be equivalent so pick cheapest treatment
Cost effectivenesss analysis?
Used to compare interventions that have a common outcome. Need to decide if extra cost of one treatment is worth the extra benefit it brings.
Cost benefit analysis?
All inputs and outputs given monetary value and compared. Difficulty putting value on life however
