Rationing Health Care Part 1 Flashcards
Definition of Rationing
“To limit the beneficial health care an individual desires by any means - price or non-price, direct or indirect, explicit or implicit”
Health Care rationing is considered unavoidable by economists, why?
Desires/Needs are infinite, yet resources are limited. There are never enough resources to satisfy all human wants and needs, this is called scarcity. This means that available resources have to be used to maximize outcomes or the goal (e.g. happiness, welfare, health)
Implicit Rationing
Decide upon a max spending budget and leave unspecified what you need to do with that money, physicians must make the tough choices
Explicit Rationing
Decide which pill is and which isn’t available. Explicit rationing sets limits to resources available in combination with choices on how the scarce resources should be allocated.
Difference between Implicit and Explicit rationing
Implicit: Society determines the healthcare budget, but also leaves it to physicians to allocate resources to individual patients
Explicit: Society determines the rules that determine under which circumstances patients can claim medical services
3 instruments used to ration health care in healthcare in the Netherlands
Rationing through:
- Basic benefits package
- Mandatory deductible of 385 euro’s
- Macro budgets and ‘production limits’ –> bedside rationing/waiting
Basic benefits package
Health insurance act: (zorgverzekeringswet) and long-term care act (wet langdurige zorg) so… Almost all care except for dental care, and physiotherapy only to a limited degree
Mandatory deductible of 385 euro’s
When you need care that is outside of the basic benefits package you will have to pay out of pocket up to 385 euros afterwards the health care is ‘free’ for the receiver of the care. This has been put in place to make people consider if they really need the care before consuming it.
Macro budgets and ‘production limits’
Due to budgets health care providers can’t just keep on treating every little thing and have to make sure that how and whom they treat is the best way to allocate their resources to. This way healthcare expenses are being rationed as well.
3 positive aspects of having waiting times
- Reduces need to use other rationing mechanisms
- Existing waiting times and waiting lists can reduce the flow of referrals.
- Waiting lists can help to use available capacity optimally (planning device)
3 Negative aspects of having waiting times
- Loss of quality of life during waiting
- Health state may worsen during waiting time
- Recovery time may increase with waiting time
OCED: Optimal waiting times in systems without financial barriers to care are not zero. Why?
Without financial barriers, if you don’t have any other limitations, or rationing in your system. Then you shouldn’t have zero waiting lists because that means the whole system is unrestricted; which will lead to very expensive health care. The problem here is that optimal waiting time differs per disease, per situation, per individual etc. and may not be only based on medical need.
What is waiting time guarantee?
A waiting time guarantee is a commitment from a firm (or healthcare institute/ provider) to serve its customers within a specified period of time.
How can waiting times be reduced?
Waiting times can be reduced by having more beds and doctors. Using combined policies; with sanctions and competition the effect on waiting times will be strong.
Negative effects of waiting time guarantee
We are transferring the low need people to the high priority group. Not because of the fact that they need help, but because they are waiting too long. High priority spots are taken by the low priority which is a bad thing. This means that healthcare is not being distributed on the basis of need but on the basis of who comes first and who can apply the most pressure since people with higher SES engage more actively with the system and exercise pressure when experiencing long delays.
3 explenations for lower waiting times for higher SES people
1) People with higher SES engage more actively with the system and exercise pressure when they experience long delays
2) People with higher SES may have better social networks (“know someone”) and use them to gain priority
3) People with higher SES may have a lower probability of missing scheduled appointments and thus get treated sooner.
4 criteria used by Dutch health care in limiting the basic benefits package
1) Necessity
2) Effectiveness
3) Cost-effecitveness
4) Feasibility
Hard rationing
This pill is not in the care package so you don’t get it.
Soft rationing
It is not in the care package but if you want to pay for it you can.
Healthcare goals
1) Quality of care
2) Access: financial and physical
3) Efficiency
4) affordability
Prospective health
The years left to live * QoL = …QALY’s
Rule of Rescue
Priority to the patient that has less than 3 years to live
Absolute shortfall
Disease related health loss
Proportional shortfall
Disease related health loss devided by the remaining health expectation in absence of the disease
Fair innings
Takes past health into account
Decision making framework in the Netherlands
0.11-0.40 –> 20.000 euro
0.41-0.70 –> 50.000 euro
0.71-1.00 –> 80.000 euro
3 main systems to ration care in Belgium
- Closed end budgets
- Supply quota
- Demand-side cost-sharing
