PaSS

Question 1

What is priority setting?

Answer 1

Decisions about allocation of resources between competing claims of different services and patients.

Question 2

What is rationing?

Answer 2

The effect priority setting decisions will have on a patient.

Question 3

What are the two forms of rationing?

Answer 3

1) Explicit rationing - based on defined rules of entitlement.
2) Implicit rationing - Care is limited, but decisions or reasoning isn’t clearly expressed.

Question 4

Describe Implicit rationing.

Answer 4

• Allocation of resources through individual clinical decisions without criteria for those decisions being implicit.
• Can lead to inequities & discrimination.
• Open to abuse.
• Decisions based on perceptions of social deservingness.
• Doctors appear increasingly unwilling to do it.

Question 5

Describe Explicit rationing.

Answer 5

• Use of institutional procedures for the systematic allocation of resources within the healthcare system.
• Care is limited and decisions & reasoning are explicit.
• Technical processes ( assessments of efficiency & equity)
• Political processes (Lay participation)

Question 6

What are the advantages of Explicit rationing?

Answer 6

• Transparent & accountable.
• Opportunity for debate
• More clearly evidence-based
• More opportunities for equity in decision-making.

Question 7

What are the disadvantages of Explicit Rationing?

Answer 7

• Very compel
• Heterogeneity of patients & illnesses
• Patient & professional hostility
• Impact on clinical freedom
• Some evidence of patient distress

Question 8

What is the role of NICE?

Answer 8

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

Question 9

How do you measure cost?

Answer 9

• Cost of healthcare services
• Cost of the patients’ time
• Costs associated with care-giving
• Other costs associated with illness
• Economic costs (employers/employees/society)

Question 10

How do you measure benefits?

Answer 10

• Impact on health status
• Savings in other healthcare resources
• Improved productivity

Question 11

How does NICE make decisions?

Answer 11

Uses QALYs

• Below £20K per QALY = technology normally approved
• £20K - £30K = judgements take into account degree of uncertainty and any innovation with distinctive benefits not included in QALYs
• Above £30K = requirement for an increasingly stronger case