Session 8 - resource Allocation and Healthcare economics Flashcards
What are the 5 D’s of rationing in the NHS?
- Deterrent - Demands for healthcare obstructed e.g. prescriptions
- Delay - Waiting lists
- Deflection - GPs deflect demand from secondary carers
- Dilution - e.g. fewer tests, cheaper drugs
- Denial - Range of services denied to patients.
What are the 2 forms of rationing?
Explicit - Based on defined rules of entitlement
Implicit - Care is limited, but neither the decisions nor the bases for those decisions are clearly expressed
What are the criticisms of implicit rationing?
- Inequities and discrimination
- open to abuse
- Based on ‘social deservingness’
What are the pros and cons of explicit rationing?
Pro:
- Transparent and accountable
- Opportunity for debate
- More equitable
Cons:
- Very complex
- Heterogeneity of patients and illnesses
- Evidence of patient distress
What is the purpose of NICE?
Provides guidance on whether treatments can be recommended for the NHS
Appraises new drugs and devices
What are tariffs?
Payment by results. Efficient trusts can make money, incentive to work harder
Define effectiveness
The extent to which an intervention produces desired outcomes.
Define utility
The value an individual places on a health state.
What is cost effective analysis?
used to compare drugs which have a common health outcome.
is extra benefit worth extra cost?
What is cost benefit analysis?
All inputs and outputs valued in monetary terms
What is cost utility analysis?
Quality of health outcomes produced or foregone
QUALY
What are some criticisms of QUALYs?
- Do not distribute resources according to need, but according to the benefits gained per unit of cost
- Technical problems with their calculations
- QUALYs may not embrace all dimensions of benefit; values expressed by experimental subjects may not be representative of the population
- Controversy over values they embody
