Session 9 Flashcards
What is priority setting?
Decisions made to allocate resources between different services, patient groups or different elements of care.
What is rationing?
The effect that the decisions of allocation have on individual patients - the extent to which patients receives the best and worst treatment possible.
What is the combination of priority setting and rationing?
The process by which services that may be of benefit are withheld from users.
Why is there an increased demand for healthcare?
The cost of developing new technologies and treatments.
The population is aging - the population is growing, and people are living for longer and those that are, are requiring more treatments.
What is implicit rationing?
The allocation of resources through individual clinical decisions without the criteria for those decisions being explicit.
What are the drawbacks of implicit rationing?
It can lead to inequalities and discrimination.
It is open to abuse.
Decisions are made based on perceptions of ‘social deservingness’.
Doctors are more unwilling to do it.
What is explicit rationing (care rationing)?
The use of institutional procedures for the systematic allocation of resources within a healthcare system.
What are the positives of explicit rationing?
It is transparent and accountable.
It is more clearly evidence based.
There are more opportunities for equity in decision-making.
There is opportunity for debate.
What are the drawbacks of explicit rationing?
It is highly complex.
There is impact on clinical freedom.
It is open to patent and professional hostility.
There may be patient distress.
Heterogeneity of patients and illnesses.
What is NICE and what is it for?
The national institute for health and care excellence.
It provides guidance on whether a treatment can be recommended for use for the NHS.
In terms of health economics, what do the following mean:
- Scarcity.
- Efficiency.
- Equity.
- Effectiveness.
- Utility.
Scarcity = the need is greater than the supply.
Efficiency = getting the most out of limited resources.
Equity = distribution of resources is fair.
Efficiency = the extent to which an intervention produces a desired outcome.
Utility = the value an individual places on their health status.
What is the opportunity cost of a new treatment?
The value of the next best treatment alternative.
What is technical efficiency and allocative efficiency?
Technical = the most efficient way of meeting a need.
Allocative = choosing between the many needs that need to be met.
How do you measure the costs of a treatment?
The cost of healthcare services.
The cost of the patient’s time.
The costs associated with care-giving.
Other costs associated with illness.
How do you measure the benefit of a new treatment?
The impact it has on the patients health status.
Savings that it has in other healthcare resources.
Improved productivity.
How do you compare costs and benefits of a treatment?
Cost-minimisation analysis.
Cost-effective analysis.
Cost-benefit analysis.
Cost-utility analysis.
What is cost-minimisation analysis?
The outcomes assumed to be equivalent, only focussing on the cost.
The outcomes are rarely equivalent, however.
What is cost-effectiveness analysis?
Comparing drugs or interventions that have a common health outcome, comparing them in units of the health outcome.
The benefits must be calculated and compared against to see how much better something is, compared to the price difference.
What is cost-benefit analysis?
All inputs and outputs are valued in monetary terms. However, it is difficult to quantify the cost of improving someone’s life by a certain amount or saving it.
What is cost-utility analysis?
A type of cost effectiveness analysis that focuses on the quality of health outcomes produced. It is based on the cost per QALY.
What is a QALY and how is it calculated?
Quality adjusted life years. It is calculated based on a year of perfect health. If the health has only been a proportion of the ‘perfect health’ then it will account for less than a year.
It is calculated using a generic HR-QoL tool (health-related quality of life), the EQ-5D.
How do you calculate a QALY, and a cost per QALY?
The quality of their life multiplied by the quantity of life gained.
Divide the cost of a treatment by the number of QALYs gained from that treatment.
How does NICE make decisions about treatments?
Below £20,000 per QALY, a treatment is approved.
Between £20,000 - £30,000, there is a degree of uncertainty.
Above £30,000, a much stronger case is required to approve the treatment.
What are some criticisms of QALYs?
Does not distribute the resources according to need but benefits per unit of cost.
May disadvantage common conditions.
It does not assess the impact on carers or family.
