Session 8 - Resource Allocation

Question 1

What are the 5 D’s of rationing in the NHS?

Answer 1

Denial - range of services denied to patients
Deterrent - getting people to pay for things such as prescriptions
Delay - waiting lists
Deflections - have to get through a GP to get specialist services
Dilution - Cheaper drugs and fewer tests

Question 2

What is explicit rationing?

Answer 2

Rationing based on rules of entitlement
priorities defined systematically
everything is outlined
reasoning behind rationing is made clear

Question 3

What two processes are involved in explicit rationing?

Answer 3

Technical processes (assessment of efficacy and equity)
political processes (lay participation)

Question 4

What are the advantages of explicit rationing?

Answer 4

• There is opportunity for debate
• Transparent and accountable
• Use of EBP

Question 5

What are the disadvantages of explicit rationing?

Answer 5

• Very complex
• Evidence of Patient distress
• Patient + professional hostility
• Threat of clinical freedom

Question 6

What is implicit rationing?

Answer 6

Care is limited but neither the decision or basis for rationing decisions are clearly expressed. Care was offered (or withheld) based on clinical need.

Question 7

What are the advantages of implicit rationing?

Answer 7

More sensitive to complexity of medical decisions and individual patient needs

Question 8

What are the disadvantages of implicit rationing?

Answer 8

• Open to abuse
• Can lead to inequalities and discrimination
• Decisions may be based on perception of social deservingness

Question 9

Rationing can be done are many levels, what are these levels?

Answer 9

How much do we give to the NHS compared to other services?
Within the NHS were is the money spent?
How much do we allocate?
How do we allocate money between different patients in same group

Question 10

What is the role of NICE in terms of resource allocation?

Answer 10

provides guidance to whether treatments can be recommended for us in the NHS
Recommendations become binding
They appraise new drugs and devices (whilst doing this local NHS organisations can make their own choice)

Question 11

Why do we need resource allocation in healthcare?

Answer 11

• Resources are scarce and could be used in other ways
• So it is clear and explicit who benefits from public expenditure
• Demand out strips supply