Session 8 Flashcards
Explain the inevitability of rationing in health care systems
Deterrent - demands for healthcare are obstructed (e.g. prescription and dental charges)
Delay - waiting lists
Deflection - GPs deflect damage from secondary care (gatekeepers)
Dilution - fewer tests, cheaper drugs
Denial - range of services denied to patients e.g. reversal of sterilisation, infertility treatment
Define the terms ‘explicit’ and ‘implicit rationing’ and describe some pros and cons for both
Explicit - defined rules of entitlement, institutional procedures for the systematic allocation of resources
++ - transparent, accountable, opportunity for debate, evidence based, equity
– - complex, heterogeneity of patients and illnesses, hostility, threat to clinical freedom, patient distress
Implicit - care is limited but decisions and basis for decisions are not learnt expressed
++ - more sensitive to so,plenty of medical decisions and personal and cultural preference
– - can lead to inequities, discrimination, open to abuse and (un)favourable treatment, decisions based on perceptions of ‘social deservingness’, doctors increasingly unwilling to do it
Explain and distinguish between ‘cost effectiveness, cost benefit, cost utility, and cost minimisation analyses
Cost effectiveness - compare interventions with a common health outcome, compared in terms of cost per unit outcome, extra benefit worth extra cost?
Cost benefit - inputs and outputs valued in monetary terms, difficulty letting monetary value on non monetary benefits e.g. lives
Cost utility - type of effectiveness, quality of health outcome predicted, QALY, compare with cost per QALY
Cost minimisation - outcomes assumed to be equivalent, focus on input, cheapest, not often relevant (outcomes rarely equivalent)
Consider advantages and disadvantages of using QALYs as a method of resource allocation
Advantages - measured with HRQoL instrument (e.g. SF-36), compares benefits and costs, used by NICE, integrated with price of treatment using incremental cost effectiveness (ICER)
Disadvantages - do not distribute resources according to need but by benefits gained per unit of cost, controversy about values they embody, atypical care and patients
CCGs forced to prioritise NICE approved interventions –> skewed priorities
Explain healthcare economics
The allocation of scarce resources efficiently and equitably
Is concerned with making the most of societies’ resources by maximising social benefits subject to the constraints imposed by resource availability
Explain the term ‘opportunity cost’
Once you have used a resource in one way, you no longer have to use it another way
Value of next best alternative use of those alternatives
Measured in benefits foregone
Ensure that we do those activities whose benefits outweigh their opportunity cost
Differentiate between technical efficiency and allocative need
Technical efficiency - the most efficient way of meeting a need (how)
Allocative need - choosing between the many needs to be met (who)
Discuss the impact of scarce resources on the work of doctors
Choices have to be made - focus on treatments that improve the quality and/or length of someone’s life and at the same time, are an effective use of NHS resources
Priorities must be set - clear and explicit who benefits
Need to be clear about whether spending is ‘worth it’
Demand outstrips supply
Need to tackle rationing
