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HaDSoc > Resource Allocation > Flashcards

Resource Allocation Flashcards

1
Q

Why is expenditure on healthcare rising?

A

Ageing population - increased incidence of long term conditions and cancer
Costs of new technology eg cancer therapies, drugs to increase survival, prophylaxis

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2
Q

Why do priorities need to be set?

A

Resources are scarce and could be used in other ways
Need to be clear who benefits from public expenditure for ethical reasons
Need to be clear about if it’s worth it
Scarcity of resources

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3
Q

What are the ways of rationing in the NHS?

A

Deterrent - demands for healthcare are obstructed eg prescription charged and dental charges
Delay - waiting lists
Deflections - GPs deflect demand from secondary care
Denial - range of services denied to patients eg reversal of sterilisation, infertility treatment

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4
Q

What is implicit rationing?

A

Allocation of resources through individual clinical decisions without the criteria for those decisions being explicit

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5
Q

Problems with implicit rationing?

A

Can lead to inequities and discrimination
Open to abuse
Decisions based on ‘social deservingness’
Doctors are increasingly unwilling to do it

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6
Q

Advantages of implicit rationing?

A

More sensitive to complexity of medical decisions, needs, personal and cultural preferences of patients

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7
Q

What is explicit rationing?

A

Allocation of resources based on rules of entitlement. Decisions and reasons behind them are explicity

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8
Q

How is explicit rationing done?

A

Technical processes eg assessment of efficiency and equity

Political processes eg lay participation

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9
Q

Advantages of explicit rationing?

A

Transparent, accountable
Opportunity for debate
Use of evidence based practice
Opportunity for equity in decision-making

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10
Q

Disadvantages of explicit rationing?

A 
Complex
Heterogeneity of patients and illnesses
Patient and professional hostility
Threat to clinical freedom
Evidence of patient distress
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11
Q

Who determines the priorities?

A

Clinical commissions groups

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12
Q

What are the different levels of rationing?

A

How much to NHS?
How much to allocate across each sector eg mental health, cancer
How much to specific interventions within each sector eg end of life drugs, curative intent
Interventions between different patients within the same group eg which patients with advanced cancer should be treated?
How much to invest in a patient once an intervention has begun? Eg how low should cholesterol be lowered?

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13
Q

What role do NICE have in rationing?

A

Provides guidance on the use of selected new and established health technologies

Appraises the clinical benefits and the costs of interventions

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14
Q

Why is the way that NICE appraise and implement interventions controversial?

A

If not approved, then patients are denied access

If approved, NHS organisations must find them, which can have adverse effects on other priorities

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15
Q

What are healthcare resource groups?

A

Standard groupings of similar treatments using common levels of healthcare resource - unit of currency
When a hospital treats a patient, the diagnosis and treatment are recorded and coded.
The HRG assigned tariff is paid
If complications occur, trust may lose money
No payment after ‘never’ events

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16
Q

What are issues with letting the public decide how rationing is done?

A

Most think everyone should have healthcare regardless of cost
Value heroic interventions and certain patient groups
Willing to discriminate against those partially responsible for illness
Public priorities differ from those of doctors and policy makers
May be contrary to equate and equal access according to need
May not be cost effective

17
Q

Why do we need resource allocation?

A

Demand exceeds supply

18
Q

Define scarcity

A

Needs outstrip resources making prioritisation inevitable

19
Q

Define efficiency

A

Getting the most out of limited resources

20
Q

Define equity

A

Extent to which distribution of resources is fair

21
Q

Define effectiveness

A

Extent to which an intervention gives wanted outcomes

22
Q

Define utility

A

Value an individual places on a health state

23
Q

Define opportunity cost

A

Once you have used a resource in one way, no longer have it to use in another way
Eg cost of hiring someone = £20,000
Overnight hospital stay for a sick child = £400
Hire someone, lost benefit to 50 children

Measured in benefits forgone

24
Q

What is cost minimisation analysis in comparing costs and benefits?

A

Outcomes assumed to be equivalent eg all hip prostheses improve mobility equally, so should choose the cheapest one

25
Q

What is cost effectiveness analysis when comparing costs and benefits

A

Used to compare drugs or intervening with a common health outcome
Compared in terms of cost per unit outcome
Eg BP - cost per reduction of 5mmHg

26
Q

What is cost benefit analysis when comparing costs and benefits?

A

All inputs and outputs are valued in monetary terms

Can allow comparisons with interventions outside healthcare

27
Q

What are some difficulties with cost benefit analysis?

A

Methodological difficulties

Eg putting monetary value on non-monetary benefits such as lives saved

28
Q

What is cost utility analysis?

A

Focuses on quality of health outcomes produced or foregone

Most frequently measured is QALY - interventions can be compared in cost per QALY terms

29
Q

What is a QALY?

A

Quality Adjusted Life Year
Uses a single index incorporating quality and quantity of life
1 perfect year of health = 1 QALY
10 years of 10% of health = 1 QALY

30
Q

How is health measured in a QALY?

A

Using a generic HR-QoL instrument such as EQ-5D

31
Q

What do QALYs allow for?

A

Broad comparisons across different programmes

32
Q

How do NICE assess cost effectiveness using QALYs?

A

Integrate the QALY score with the price of treatment using the incremental cost effectiveness ratio (ICER)
Gives a cost per QALY figure

33
Q

What are the boundaries for deciding on a new intervention in cost per QALYs?

A

£30k/QALY - needs an increasingly stronger case

34
Q

Criticisms of QALYs?

A

Don’t distribute resources according to need but by benefits gained or unit of cost

Technical problems with their calculations

QALYs may not cover all dimensions of benefit - values expressed by experimental subjects may not be representative of the population

Controversies about the values they embody

35
Q

Issues with RCTs when working out QALYs?

A

RCT evidence

  • comparison of therapies may differ
  • length of follow up
  • atypical patients
  • atypical care
  • sample sizes
  • limited generalisability

HaDSoc (11 decks)

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