Resource Allocation Flashcards
Why does resource allocation need to take place?
Resources are scarce and could be used in many ways. Ethics: needs to be clear and explicit about what we are trying to achieve and who benefits from public expenditure.
What is implicit rationing?
Implicit rationing is the allocation of resources through individual clinical decisions without the criteria for those decisions being explicit.
What are the flaws of implicit rationing?
Can lead to inequities and discrimination, is open to abuse, decision based on perceptions of social deservingness and doctors are generally increasingly unwilling to do it.
What is explicit rationing?
Explicit health care rationing or priority-setting is the use of institutional procedures for the systematic allocation of resources within health care system. Care is limited and the decisions are explicit, as is the reasoning behind those decisions. Technical processes – e.g. Assessments of efficiency and equity. Political processes – e.g. Lay participation.
What are the advantages and disadvantages of explicit rationing?
Advantages: Transparent, accountable, Opportunity for debate, More clearly evidence-based, More opportunities for equity in decision-making
Disadvantages: Very complex, Heterogeneity of patients and illnesses, Patient and professional hostility, Impact on clinical freedom, Some evidence of patient distress.
What is the purpose of NICE?
Set up to ‘enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources’
Provides guidance on whether treatments (new or existing) can be recommended for use in the NHS in England. NICE is asked to appraise significant new drugs and devices to help make sure that effective and cost effective products are made available to patients quickly and to minimise variations in the available of treatments.
What are the issues with NICE approving and not approving treatments?
If not approved, patients are effectively denied access to them (except for individual requests). If approved, local NHS organisations must fund them (if clinically appropriate), sometimes with adverse consequences for other priorities.
Define scarcity, efficiency, equity, effectiveness and utility?
Scarcity: Need outstrips resources. Prioritisation is inevitable
Efficiency: Getting the most out of limited resources
Equity: The extent to which distribution of resources is fair
Effectiveness: The extent to which an intervention produces desired outcomes
Utility: The value an individual places on a health state
What is opportunity cost?
Opportunity Cost: Once you have used a resource in one way, you no longer have it to use in another way. When deciding to spend resources on a new treatment, those resources cannot now be used on other treatments. The opportunity cost of the new treatment is the value of the next best alternative use of those resources. – Cost is viewed as sacrifice rather than financial expenditure. Opportunity cost is measured in benefits foregone.
What is the difference between technical efficacy and allocative efficacy?
Technical efficiency – you are interested in the most efficient way of meeting a need (e.g. should antenatal care be community or hospital-based?). Allocative efficiency – you are choosing between the many needs to be met (e.g. fund hip replacements or neonatal care?).
What is economic evaluation?
Comparison of resource implications and benefits of alternative ways of delivering healthcare. Can facilitate decisions so that they are more transparent and fair.
How can we measure costs?
Identify, quantify and value resources needed
Categories of costs: – Costs of the healthcare services – Costs of the patient’s time – Costs associated with care-giving – Other costs associated with illness – Economic costs borne by the employers, other employees and the rest of society.
How do we measure benefits?
Benefits are harder to measure. Improved (or maintained) health hard to value. Categories of benefits/consequences: – Impact on health status (in terms of survival or quality of life or both); – Savings in other healthcare resources (such as drugs, hospitalisations, procedures, etc.) if the patient’s health state is improved – Improved productivity if patient, or family members, returns to work earlier.
What is the cost minimisation analysis?
Outcomes assumed to be equivalent. Focus is on costs (i.e. only the inputs). Not often relevant as outcomes rarely equivalent. Possible example: – Say all prostheses for hip replacement improve mobility equally. Choose the cheapest one.
What is cost effectiveness analysis?
Used to compare drugs or interventions which have a common health outcome e.g. reduction in blood pressure. Compared in terms of cost per unit outcome e.g. cost per reduction of 5mm/Hg. If costs are higher for one treatment, but benefits are too, need to calculate how much extra benefit is obtained for the extra cost. Key question: Is extra benefit worth extra cost?
