Rescource Allocation And Health Economics

Question 1

Why do we need to set priorities within the NHS ?

Answer 1

1) because of the scarcity of resources ( demands outstrips policies)

Question 2

What are the two forms of rationing ?

Answer 2

1) Explicit rationing

2) implicit rationing

Question 3

What is explicit rationing ?

Answer 3

• rationing which can be explained through rules and reasoning for why we have rationed this way.
• there is systematic allocation of resources within health care system

Question 4

What is implicit rationing

Answer 4

• allocation of recourses through individual clinical decisions without an actual reasoning /criteria being used.

Question 5

What are disadvantages of implicit rationing ?

Answer 5

• can lead to discrimination and inequities
• open to abuse
• decisions based on perception of social deservingness
• doctors increasingly unwilling to do it

Question 6

What are the advantages of explicit rationing ?

Answer 6

1) more clearly evidence based
2) more opportunities for equity In decision making
3) transparent and accountable

Question 7

What are the disadvantages of explicit rationing ?

Answer 7

• very complex
• impact on clinical freedom ( doctors cannot make their own choice on whether to give patients medication or not )

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Question 8

What do we need to consider when rationing In the NHS ?

Answer 8

• effectiveness
• costs
• equity
• treatment alternatives

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Question 9

Define scarcity

Answer 9

Demands outstrip resources

• prioritisation is inevitable

Question 10

Define equity

Answer 10

The extent to which distribution of resources is fair

Question 11

Define efficiency in terms of health economics

Answer 11

Getting the most out of limited rescources

Question 12

Define effectiveness in terms of health economics

Answer 12

The extent to which an intervention produces desired outcomes

Question 13

Define opportunity cost

Answer 13

The benefits others lose out on by using resources in one way and not another way.

For example , by using 8100£ on 3 rounds of IVF, we could have funded 10 cataract surgeries

• opportunity cost is measured in benefits foregone

Question 14

How do you measure costs of rescources ?

Answer 14

• costs of the patients time
• costs of the healthcare services
• costs associated with care giving
• costs associated with illness

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Question 15

How do you measure benefits ?

Answer 15

• impact of care on health status
• impact of care on savings in other healthcare resources
• Impact of care on productivity

Question 16

What are the 4 ways we can compare costs and benefits ?

Answer 16

1) cost minimalisation analysis
2) cost effectiveness analysis
3) cost benefit analysis
4) cost utility analysis

Question 17

What is cost minimisation analysis ?

Answer 17

• cost minimisation analysis compares the costs of two similar interventions to ascertain which one is less expensive

Question 18

What is cost effectiveness analysis ?

Answer 18

• a tool used to aid decisions about which medical care should be offered.
• compares the effectiveness of two or more interventions relative to their cost.l

Question 19

What is cost benefit analysis

Answer 19

Process used to measure the benefits of an intervention minus the costs associated with taking that action

Question 20

What is cost utility analysis

Answer 20

Type of cost effectiveness analysis

• uses a QALY ( quality adjusted life year ) as a measure
• interventions can be compared in cost per QALY terms

Question 21

What is QALY and why do we use it ?

Answer 21

WHY WE USE IT : to use cost effectiness as a guide to decision making.

• 1 year of perfect health = 1 QALY
• Assumes that 1 year in perfect health = 10 years with a quality of life of 0.10 perfect health

Question 22

What are the two factors a QALY takes into consideration. .

Answer 22

Quality of life + quantity of life

Question 23

AN EXAMPLE COMPARING two treatments using QALY

Answer 23

Qol with treatment A is 0.95 ( at a cost of £50 per year)

• patient expected to live 23 years.
• 23 x 0.95 = 21.85 QALY on A.
• Qol without treatment is 0.7 so QALY without treatment is 0.7 x 23= 16.1
• difference in QALY : 21.85-16.1 = 5.75
• total cost of treatment : 23 x50 = 1150
• 1150/ 5.75 = £200 cost per QALY gained

Question 24

How does NICE a make its decision based on cost Per QALY?

Answer 24

• below 20k per QALY technology will normally be improved
• £20-30k : NICE will take account of degree of uncertainty ,
• above 30k : need an increasingly stronger case

Question 25

Criticisms of QALY

Answer 25

• do not distribute rescources according to need , but according to benefits gained per unit cost
• may disadvnatge common conditions
• technical problems with their calculations
• QALYs do not assess impact on careers or family