S8 - Resource Allocation

Question 1

What is scarcity in health economics

Answer 1

More need than resources available.

Question 2

What is efficiency in terms of health economics?

Answer 2

Getting the most out of limited resources

Question 3

What is equity in health economics?

Answer 3

Extent to which distribution of resources is fair

Question 4

What is effectiveness in health economics?

Answer 4

Extent to which an intervention produces desired outcomes

Question 5

What is utility in health economics?

Answer 5

The value an individual places on a health state

Question 6

What is opportunity cost in health economics?

Answer 6

Once a resource is used in one way, you can no longer use it in another way

Question 7

What is priority setting?

Answer 7

Decisions about the allocation of resources between competing claims of different services, different patient groups or different elements of care

Question 8

What is rationing?

Answer 8

The effect of the decisions, made in priority setting, on individual patients

Question 9

What is explicit rationing?

Answer 9

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.

Question 10

Pros and cons of explicit rationing…

Answer 10

Pros: transparent and accountable, allows debate, more evidence-based, more equitable

Cons: complex, hostility, impact on clinical freedom, can cause distress

Question 11

What is implicit rationing?

Answer 11

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

Question 12

Pros and cons of implicit rationing…

Answer 12

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

Question 13

What is technical efficiency?

Answer 13

Interested in the most efficient way of meeting a need

E.g. should antenatal care be community or hospital-based?

Question 14

What is allocative efficiency?

Answer 14

Choosing between the many needs to be met

E.g. fund hip replacements or neonatal care?

Question 15

How do you measure costs in health economics?

Answer 15

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

Question 16

How do you measure benefits in health economics?

Answer 16

Think about:

Impact on health status
Savings in other healthcare resources
Improved productivity

Question 17

How do you compare costs and benefits?

Answer 17

Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis

Question 18

What are QALYs?

Answer 18

Quality Adjusted Life Years

Based off survival and quality of life

Question 19

How do you measure QALYs?

Answer 19

1 year of perfect health = 1 QALY

1 year of perfect health = 10 years with a quality of life of 0.10

Question 20

What are Patient Reported Outcomes (PROs)?

Answer 20

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.

Question 21

What are Patient Reported Outcome Measures (PROMs)?

Answer 21

Tools/instruments used to measure PROs - turns subjective experiences into numerical scores that can easily be utilised.

Question 22

Why are PROs used?

7 points

Answer 22

1. Need to focus on patient’s concerns (patient centred care).
2. Biomedical tests only show one part of the picture.
3. There’s more conditions nowadays that need to be managed more than cured.
4. Need to think about iatrogenic (e.g. illness caused by medication) effects of care
5. Quality of life if usually more important than quantity of life.
6. Patients and clinicians have different priorities and perspectives.
7. Need to consider burden and psychological impact of symptoms.

Question 23

What is Health Related Quality of Life (HRQoL)?

Answer 23

The functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient.

Question 24

What is Quality of Life (QoL)?

Answer 24

Multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning.

Question 25

What are two important properties of PROMs?

Answer 25

Reliability (is the instrument accurate over time and consistent?)

Validity (does the instrument actually measure what it’s intended to measure?)

Question 26

What are two types of PROMs?

Answer 26

Generic (can be used in any patient population)

Specific (are disease/site/dimension specific)

Question 27

Advantages and Disadvantages of specific instruments…

Answer 27

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