S8 - Resource Allocation Flashcards
What is scarcity in health economics
More need than resources available.
What is efficiency in terms of health economics?
Getting the most out of limited resources
What is equity in health economics?
Extent to which distribution of resources is fair
What is effectiveness in health economics?
Extent to which an intervention produces desired outcomes
What is utility in health economics?
The value an individual places on a health state
What is opportunity cost in health economics?
Once a resource is used in one way, you can no longer use it in another way
What is priority setting?
Decisions about the allocation of resources between competing claims of different services, different patient groups or different elements of care
What is rationing?
The effect of the decisions, made in priority setting, on individual patients
What is explicit rationing?
Based on defined rules of entitlement.
Use of institutional procedures for the allocation of resources within a health care system.
Tends to involve people it’ll effect.
Pros and cons of explicit rationing…
Pros: transparent and accountable, allows debate, more evidence-based, more equitable
Cons: complex, hostility, impact on clinical freedom, can cause distress
What is implicit rationing?
Care is limited. Decisions and for those decisions aren’t clearly expressed.
Allocation of resources through individual clinical decisions without criteria for those decisions being explicit.
Discreet
Pros and cons of implicit rationing…
Pros: -
Cons: can lead to inequities and discrimination, open to abuse, decisions are based on perceptions or “social deservingness”, doctors appear increasingly unwilling to do it
What is technical efficiency?
Interested in the most efficient way of meeting a need
E.g. should antenatal care be community or hospital-based?
What is allocative efficiency?
Choosing between the many needs to be met
E.g. fund hip replacements or neonatal care?
How do you measure costs in health economics?
Think about:
Costs associated with care-giving Costs of the patient’s time Costs of the healthcare services Other costs associated with illness Economic costs from employers/employees/rest of society
How do you measure benefits in health economics?
Think about:
Impact on health status
Savings in other healthcare resources
Improved productivity
How do you compare costs and benefits?
Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis
What are QALYs?
Quality Adjusted Life Years
Based off survival and quality of life
How do you measure QALYs?
1 year of perfect health = 1 QALY
1 year of perfect health = 10 years with a quality of life of 0.10
What are Patient Reported Outcomes (PROs)?
Any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician/anyone else.
What are Patient Reported Outcome Measures (PROMs)?
Tools/instruments used to measure PROs - turns subjective experiences into numerical scores that can easily be utilised.
Why are PROs used?
7 points
- Need to focus on patient’s concerns (patient centred care).
- Biomedical tests only show one part of the picture.
- There’s more conditions nowadays that need to be managed more than cured.
- Need to think about iatrogenic (e.g. illness caused by medication) effects of care
- Quality of life if usually more important than quantity of life.
- Patients and clinicians have different priorities and perspectives.
- Need to consider burden and psychological impact of symptoms.
What is Health Related Quality of Life (HRQoL)?
The functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient.
What is Quality of Life (QoL)?
Multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning.
What are two important properties of PROMs?
Reliability (is the instrument accurate over time and consistent?)
Validity (does the instrument actually measure what it’s intended to measure?)
What are two types of PROMs?
Generic (can be used in any patient population)
Specific (are disease/site/dimension specific)
Advantages and Disadvantages of specific instruments…
Advantages: relevant, sensitive to change, acceptable to patients
Disadvantages: can’t use with those who don’t have the disease, limited comparison, may not detect unexpected effects
