Resource Allocation Flashcards
What are the possible characteristics you could consider when weighing up how to allocate resources
Age Social worth Personal responsibility First come, first served Lottery
What is the problem with choosing on basis of age
- ageism
- fair innings argument
Allocation based on age would be arbitrary
Older and younger adults value their lives equally
Ageism
- Assumes that younger individuals will live longer than older individuals
- Assumes that older adults have less value
Fair innings argument
- people generally value their lives equally irrespective of age
- but at a certain age, one can be said to have had a fair share of life
- any additional life over this ‘fair innings’ is a bonus and as such does not warrant public resources
- assumes that individuals over a certain age would not be entitled to any form of nursing or basic medical care
Who decides what would count as fair innings?
What is the problem with choosing on the basis of social worth
How would we decide?
- what would be counted as a ‘valuable contribution to society’?
- may be biased against those with disability
What is the problem with choosing on the basis of dependents
-dependents argument
Dependents argument
-if a single mother of 3 children dies, then the lives of her children will be blighted and society will have to pick up the costs of caring for her children
Patients without dependents will still have loved ones whose lives will be blighted by their death
Would a single mother of 3 have priority over a single mother of 1?
Patients without dependents value our lives as much as those with dependents
What is the problem with choosing on the basis of personal responsibility
To what extent are people responsible for the diseases they acquire?
Not all factors are within our control
- upbringing
- education
- social background
- genetics
Should individuals who are responsible for their health problems be denied healthcare?
- extreme sports
- workaholics and stress related disorders
Would be risk imposing our personal prejudices on others?
How does justice relate to resource allocation
The right to life is a fundamental right
If we believe that everyone is equal, then everyone has an equal right to life and an equal life to be saved
Choosing between people on grounds of age, social worth, personal responsibility would be an injustice
Individuals may choose to sacrifice their lives for others but a just society cannot impose that self-sacrifice
How would we choose between diseases
QALYs
What is a QALY
-how is it calculated
Gives a measure of the number of life years gained by an intervention adjusted for quality of life
1 year of healthy life = 1 QALY
1 year of unhealthy life = <1QALY
Death = 0 QALY
If cost of intervention known, can calculate cost per QALY
Preference score - gives an adjustment between -1 and +1 based on the predicted quality of life associated with a particular physical condition
-based on standardised questionnaires focusing on function (mobility, personal self care, communication)
What are the pros and cons of QALYs
Benefits
- gives a reproducible, quantifiable measure of benefit and cost effectiveness allowing comparisons of treatments
- the ‘best’ treatments are those that give the most QALY per $
Problems
- biased against people with disabilities
- ageist
- doesn’t distinguish between life saving and life improving treatments
- subjectivity of preference scores
- equates quality of life with value of life
What are the pros and cons of EBM approaches
Pros
-uses clinical evidence to determine what interventions should be provided
Cons
- biased towards medical perspectives as to what counts as health benefit
- interventions where little research is done are likely to be deprioritised
- interventions where there is a lot of research is likely to be prioritised
- potential for industry bias
Describe the approach of asking for public opinion and the pros and cons of this approach
Asking the public may help get a better handle on what most people think are important in terms of healthcare priorities
Pros
-there has been evidence of changes provoked by intense public opinion
Cons
- vulnerable groups who lack strong advocates may not have a voice
- individuals with conditions that evoke less public sympathy may not be supported
- poor public knowledge of diseases and misunderstanding of the implications of their choices may lead to more harm than good
Describe the argument for personal choice
We all have different health priorities
Why not give individuals the money to invest in a personal health insurance plan of their choice
-they could choose a policy that focused on illness at working age or one that provided for cosmetic surgery but not very expensive interventions such as ITU or dialysis
What is the problem with the personal choice argument
Our healthcare priorities and perceptions of illness change with time
Would the inevitable differences in healthcare access be socially acceptable
What if the type of policy chosen was largely socially determined?
Describe the primary prevention argument
What is the problem with this argument
If you invest in primary prevention, more lives could be saved as you are addressing the initial cause of the problem
This assumes that
- you know what the underlying cause is
- you can fix the underlying cause
- that fixing the underlying cause won’t cause new problems
- you won’t address the condition that has occured as a result
What are the possible purposes of healthcare
Is it to save a maximum number of lives?
Is it to help us when we’re ill?
