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_Sem 1. PASS I NOTES > PASS S9 - Resource allocation and PROMs > Flashcards

PASS S9 - Resource allocation and PROMs Flashcards

1
Q

Impact of scarce resources on the work of doctors

A

Demand outstrips supply
Difficult decisions have to be made
Priorities have to be set: ETHICS

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2
Q

Name the two types of rationing

A

Explicit

Implicit

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3
Q

What is implicit rationing?

A

The allocation of resources through individual clinical decisions without the criteria for those decisions being explicit
Can lead to inequities and discrimination

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4
Q

What is explicit rationing?

A

The use of institutional procedures for the systematic allocation of resources within health care system

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5
Q

Advantages of explicit rationing

A

Opportunity for debate
Transparent, accountable
More clearly evidence-based

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6
Q

Disadvantages of explicit rationing

A

Very complex
Patient and professional hostility
Impact on clinical freedom
Some evidence of patient distress

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7
Q

What is NICE?

A

National Institute for Health and Care Excellence
Enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources

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8
Q

What are the 6 basic concepts in health economics?

A 
Scarcity 
Efficiency 
Equity
Effectiveness 
Utility 
Opportunity cost
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9
Q

What is opportunity cost?

A

Once you have used a resource in one way, you no longer have it to use in another way
Measured in BENEFITS FOREGONE

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10
Q

What is technical efficiency?

A

You are interested in the most efficient way of meeting a need
eg. should antenatal care be community or hospital-based?

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11
Q

What is allocative efficiency?

A

You are choosing between the many needs to be met

eg. fund hip replacements or neonatal care?

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12
Q

What are the 4 types of economic evaluation?

A

Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis

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13
Q

Explain cost minimisation analysis

A

Outcomes assumed to be equivalent
Focus is on the cost
eg. all prostheses for hip replacement improve mobility equally - choose the cheapest one
(not often relevant as outcomes rarely equivalent)

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14
Q

Explain cost effectiveness analysis

A

Used to compare drugs or interventions which have a common health outcome
Compared in terms of cost per unit outcome
Is extra benefit worth extra cost?

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15
Q

Explain cost benefit analysis

A

All inputs and outputs valued in monetary terms

Can allow comparisons with interventions outside healthcare

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16
Q

Explain cost utility analysis

A

Focuses on quality of health outcomes produced or foregone
Type of cost effectiveness analysis
Most frequently measure is QALY

17
Q

What are QALYs?

A

Quality adjusted life years
Composite of survival and quality of life
1 year of perfect health = 1 QALY
Quality of life + quantity of life = QALY

18
Q

How is quality of life measured?

A

Generic HR-QoL instrument: the EQ-5D

19
Q

Alternatives to QALYs

A

Health year equivalents
Saved-young-life equivalents
Disability adjusted life years

20
Q

Name some criticisms of QALYs

A

Controversy about the values they embody
Do not distribute resources according to need, but according to the benefits gained per unit of cost
May disadvantage common conditions
Technical problems with their calculations

21
Q

What are PROMs?

A

The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilised

22
Q

What is HRQoL?

A

The functional effect of an illness and its consequent therapy upon a patient, as perceived by a patient

23
Q

Define reliability

A

Is the instrument accurate over time and internally consistent?

24
Q

Define validity

A

Does the instrument actually measure what it is intended to measure?

25
Q

What are the two types of PROMs?

A

Generic: can be used in any patient population
Specific: disease specific, site specific and dimension specific

26
Q

Example of a generic PROM

A

EQ-5D

27
Q

Advantages of generic instruments

A

Can be used for a range of health problems
Can be used if no disease-specific instrument
Enable comparisons across treatment and condition groups

28
Q

Disadvantages of generic instruments

A

Inherently less detailed
Loss of relevance
Can be less sensitive to changes that occur as a result of an intervention

29
Q

Example of specific PROMs

A

Asthma quality of life questionnaire
Oxford hip score
Beck depression inventory

30
Q

Advantages of specific instruments

A

Very relevant content
Sensitive to change
Acceptable to patients

31
Q

Disadvantages of specific instruments

A

Can’t use them with people who don’t have the disease
Comparison is limited
May not detect unexpected effects

_Sem 1. PASS I NOTES (9 decks)

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