Resource Allocation Flashcards
Why is expenditure on healthcare rising?
Ageing population - increased incidence of long term conditions and cancer
Costs of new technology eg cancer therapies, drugs to increase survival, prophylaxis
Why do priorities need to be set?
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
What are the ways of rationing in the NHS?
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
What is implicit rationing?
Allocation of resources through individual clinical decisions without the criteria for those decisions being explicit
Problems with implicit rationing?
Can lead to inequities and discrimination
Open to abuse
Decisions based on ‘social deservingness’
Doctors are increasingly unwilling to do it
Advantages of implicit rationing?
More sensitive to complexity of medical decisions, needs, personal and cultural preferences of patients
What is explicit rationing?
Allocation of resources based on rules of entitlement. Decisions and reasons behind them are explicity
How is explicit rationing done?
Technical processes eg assessment of efficiency and equity
Political processes eg lay participation
Advantages of explicit rationing?
Transparent, accountable
Opportunity for debate
Use of evidence based practice
Opportunity for equity in decision-making
Disadvantages of explicit rationing?
Complex Heterogeneity of patients and illnesses Patient and professional hostility Threat to clinical freedom Evidence of patient distress
Who determines the priorities?
Clinical commissions groups
What are the different levels of rationing?
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?
What role do NICE have in rationing?
Provides guidance on the use of selected new and established health technologies
Appraises the clinical benefits and the costs of interventions
Why is the way that NICE appraise and implement interventions controversial?
If not approved, then patients are denied access
If approved, NHS organisations must find them, which can have adverse effects on other priorities
What are healthcare resource groups?
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
What are issues with letting the public decide how rationing is done?
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
Why do we need resource allocation?
Demand exceeds supply
Define scarcity
Needs outstrip resources making prioritisation inevitable
Define efficiency
Getting the most out of limited resources
Define equity
Extent to which distribution of resources is fair
Define effectiveness
Extent to which an intervention gives wanted outcomes
Define utility
Value an individual places on a health state
Define opportunity cost
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
What is cost minimisation analysis in comparing costs and benefits?
Outcomes assumed to be equivalent eg all hip prostheses improve mobility equally, so should choose the cheapest one
