WEEK 3 HEALTH ECONOMICS Flashcards
What are the three main sources of funding in the health services for Australia?
- Australian government
- State and territory governments
- Private
What are two key challenges for healthcare in Australia?
- Expense and affordability
2. Rising costs, driven by both volume (ageing population) and expensive technology
What are the three future goals for Australian based healthcare?
- Increased safety, quality and efficacy
- Patient-centred healthcare
- Value based healthcare
What is an example of how patient centered healthcare could improve?
- Cutting wait times at a GP
What are three questions asked when it comes to evidence based practice?
- Can it work? (the theory- even if it works in a lab doesn’t mean it works in the real world)
- Does it work (effectiveness in the real world)
- It is worth it? (Cost effectiveness)
What is the evidence application if something can work (efficacy)?
- Usually goes through regulatory approval based on evidence from clinical trials and systematic reviews
What is the evidence application if something actually DOES work (effectiveness)?
- Goes into the clinical practice as it is based on clinical guidelines from systematic reviews (including CTs)
What is the evidence application if something is worth it? (cost effectiveness)
- Goes into health policy and is formed from various methods including pragmatic trials ans systematic reviews
- Looks at the cost utility and data, and a health technology assessment.
What do pragmatic trials do?
- They evaluate the effectiveness of interventions in real life situations
What was the purpose and outcome of the ASPREE trial?
Aim was to determine whether low dose asprin can make a difference in terms of health versus adverse events (cardiovascular events)
- Outcome was that Asprin was not different between placebo and intervention groups
- Resulted in increased risk of bleeding. The benefits did not outweigh the risks.
What are the two types of efficiency in healthcare?
- Alloative effciency
2. Technical efficiency
What is allocative efficiency?
- Efficient distribution of available resources
- Considers opportunity costs
Does alocative efficiency consider opportunity costs?
- YES
What is technical efficiency?
- Efficient management of single condition
- Considers cost effectiveness (narrow set of conditions)
Does technical efficiency consider cost effectiveness?
- YES
What are the three different types of health economic analyses?
- Cost benefit analysis.
- Cost-effectiveness analysis
- Cost-utility analysis
What is involved in cost benefit analysis?
- Net costs
What is involved in cost-effectiveness analysis?
Net costs/net change in years of life.
What is involved in cost-utility analysis?
Net costs/net change in QALYs
What can you use the cost-effectiveness plane to compare?
- An intervention versus a comparator
What can the net positive costs be based on in terms of the cost effectiveness plane?
- Single entity- e.g. hospital, insurer
- State funded health services
- Entire health system
- Societal (difficult to measure)
What can the net health gain be based on in terms of the cost effectiveness plane?
- Years of life lived
- QALYs lived
- Other
Are QALYs (Quality Adjusted Life Years) subjective?
- They can be, but still used
If someone has lived for 1 year with a disease, and the utility weight= 0.8, then what is their QALY?
- Their QALY= 1* 0.8= 0.8
- So 1 year lived with the disease= 0.8 years lived WITHOUT the disease
What is the ICER in terms of the cost effectiveness plane?
- Incremental cost effectiveness ratio
- The ratio is: Net cost/ net health effect
What does ‘dominated’ on the cost effectiveness plane mean?
- It means that there are high net positive costs and an overall net health loss of the intervention
- This is NOT good
What does ‘dominant’ mean in terms of the cost effectiveness plane and what are examples?
- There is a net health gain and net negative cost which means that it is cost saving
- This is the best of both worlds
- Examples are vaccines, life saving surgery or chemo, and anti smoking cessation
What is something that many people need to consider with new biologicals compared to those other medications already on the market?
- They need to consider the cost effectiveness of them
- Those already on the market may do the job just as well and be cheaper than those new ones
- Also need to consider the side effects
What is value based healthcare?
- Only reimbursing companies if they achieve a successful outcome
- So if the patient did not show the desired outcome that helped them, they should not be reimbursed
- This encourages good practice and value
Is value based healthcare occurring now?
- NO
- The opposite is occurring
- This leads to over-servicing –> high service but doesn’t achieve good outcomes for the patients
- This will take A LONG TIME to change
What is the ‘formula’ for value based healthcare?
- Value= Health outcomes that matter to patients/ costs of delivering the outcomes
