Session 8 - Resource allocation Flashcards

1
Q

Give two factors which outline the inevitability of rationing

A

Demography

Technology

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2
Q

How does demography change increase healthcare costs?

A

Ageing population, old people cost more

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3
Q

How does technology changing increase cost of healthcare

A

New technologies expensive, expand pool of candidates. Don’t cure but offer increased survival.

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4
Q

What are the 5ds of rationing in the NHS

A

o Deterrent
 Demands for healthcare are obstructed (e.g. prescriptions)
o Delay
 Waiting lists
o Deflection
 GP’s deflect demand from secondary care (gatekeepers)
o Dilution
 Fewer tests, cheaper drugs
o Denial
 Range of services denied to patients (e.g. reversal of sterilisation)

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5
Q

What is explicit rationing?

A

Explicit health care rationing or priority-setting is the use of institutional procedures for the systematic allocation of resources within health care systems

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6
Q

Who maekes explicit rationing decisions?

A

Clinical Commisioning Groups

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7
Q

What is explicit rationing based on?

A

Defined rules of entitlement

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8
Q

Give four advantages of explicit rationing

A
  • Transparent, accountable
  • Opportunity for debate
  • Use of evidence based practice
  • More opportunities for equity in decision- making
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9
Q

Give five disadvantages of explicit rationing

A
Very complex
Heterogeneity of patients and illness
Patient and professional hostility
Threat to clinical freedom
Evidence of patient distress
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10
Q

What is implicit rationing?

A

Implicit rationing is the allocation of resources through individual clinical decisions without criteria for those decisions being explicit

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11
Q

What are two disadvantages of implicit rationing?

A

 Open to abuse

 Decisions made on perceptions of “social deservingness”

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12
Q

Give five levels or rationing

A
  1. How much allocation to NHS compared to other government priorities
    o E.g. education, defence
  2. How much to allocate across sectors
    o E.g. mental health, cancer
  3. How much to allocate to specific interventions within sectors
    o E.g. end of life drugs versus drugs with curative intent
  4. How to allocate interventions between different patients in the same group
    o E.g. which patients with advanced cancer should be treated?
  5. How much to invest in each patient once an intervention has been initiated
    o E.g. how long should cholesterol be lowered in treated patients?
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13
Q

Why was the national insitute for health and care excellence set up?

A

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’.

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14
Q

What does NICE do?

A

o NICE provides guidance on whether treatments (new or existing) can be recommended for use in the NHS in England and Wales.

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15
Q

How does NICE appraise drugs?

A

 Clinical benefit

 Costs

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16
Q

Give a negative result of NICE disapproving a treatment?

A

Patient denied access to them

17
Q

Give a negative result of NICE approving treatment

A

NHS organisations must fund treatments, with adverse consequences

18
Q

What is a tariff?

A

o Payment by Results
o When a hospital treats a patients, diagnosis and treatment are recorded
 Information decides which HRG the patient is assigned to and therefore which tariff is paid
 E.g. caesarean birth has a higher tariff than normal birth

19
Q

What do tariffs do?

A

 Incentive to become more efficient over time
 If avoidable complications occur, trusts may lose money
 ‘Never-Event’ – no payment for in-hospital maternal death from haemorrhage after elective caesarean section

20
Q

What is scarcity of resource?

A

Need outstrips resources. Prioritisation is inevitable.

21
Q

What is efficiency of resource?

A

 Getting the most out of limited resources.

22
Q

What is equity of resourceS?

A

 The extent to which distribution of resources is fair.

23
Q

What is effectiveness of reources?

A

 The extent to which an intervention produces desired outcomes.

24
Q

What is utility of resoucres?

A

 The value an individual places on a health state.

25
Q

What is an opportunity cost?

A

 Once you have used a resource in one way, you no longer have it to use in another way.

26
Q

Give four different methods of comparing cost benefit

A

Cost minimisation analysis
Cost effectiverness analysis
Cost benefit analysis
Cost utility analysis

27
Q

What is cost minimisation analyiss?

A

 Outcomes assumed to be equivalent, e.g. all hip prostheses improve mobility equally, so choose the cheapest one.
 Not often relevant as outcomes are rarely equivalent

28
Q

What is cost effectiveness analysis?

A

 Used to compare drugs or interventions which have a common health outcome
 E.g. blood pressure in terms of cost per reduction of 5mm/Hg
 Is extra benefit worth extra cost?

29
Q

What is cost benefit analysis?

A
  1. Cost benefit analysis
     All inputs and outputs valued in monetary terms
     “How much would you pay to have your hip replaced?
30
Q

What is cost utility analysis?

A

 Quality of health comes produced or foregone

 QUALY

31
Q

What is a QALY?

A

Quality adjusted life year
o Uses a single index incorporating quality and quantity of life
o 1 perfect year of health = 1 QUALY
o Assumes that 1 year in perfect health is equal to 10 years with a quality of life of 10% of perfect health.

32
Q

How is QALY measured?

A

Using a generic HR QoL instrument - EQ-5D

33
Q

How does NICE assess cost-effectiveness?

A

By integrating Qualy score with price of treatment using incremental cost effectiveness ratio

34
Q

How are cost per QUALY figures used?

A

o < £20k per QUALY technology normally approved
o £20k - £30k judgements take account of
 Degree of uncertainty
 If change in HRQoL is adequately captured in the QUALY
 Innovation that adds demonstrable and distinctive benefits not captured in the QUALY
o > £30k per QUALY technology needs an ‘increasingly stronger case’

35
Q

Give four criticisms of QUALYs

A

o Do not distribute resources according to need, but according to the benefits gained per unit of cost
o Technical problems with their calculations
o QUALYs may not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative of the population
o Controversy about the values they embody

36
Q

Why was the national insitute for health and care excellence set up?

A

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’.