Resource Allocation

Question 1

What are the 5Ds of rationing?

Answer 1

Deterrent-prescription charges
Delay-waiting lists
Denial-no funding
Deflection-GPs take demand away from secondary care
Dilution-fewer tests and cheaper drugs

Question 2

What are the two forms of rationing?

Answer 2

Explicit-defined rules of entitlement, systematic and fair with clear priority setting and openness

Implicit-allocation of resources through clinical decisions without an explanation, based on budget not patient needs

Question 3

What are the pros and cons of explicit rationing?

Answer 3

Pros: transparent, accountable, EBP, debate, equity
Cons: complex, heterogeneity of patient and illness, hostility, distress, no clinical freedom

Question 4

What are the pros and cons of implicit rationing?

Answer 4

Pros: sensitive to patient needs at point of service
Cons: leads to abuse, inequities, discrimination

Question 5

What are the different levels of rationing?

Answer 5

NHS vs education
One NHS sector vs another
Specific interventions
Patients in a group
Investment in patient once intervention started

Question 6

Why was NICE set up?

Answer 6

To enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on value of a treatment relative to alternative uses of resources

Question 7

What are tariffs?

Answer 7

Set nationally so standard payment for certain treatment leading to incentive to be efficient and transparent to make profit. Don’t get paid if there’s a never event

Question 8

What could be some issues of the public deciding on rationing?

Answer 8

Public-own experience influences it, discrimination against those responsible for their illness, treat children, support heroic ITU, not cost-effective

Question 9

Why must the NHS set priorities for resources?

Answer 9

Increasing expenditure, can’t pay for all, scarce resources, ensure clear goals, ensure money benefits people