Working within resource constraints.

Question 1

What is priority setting

Answer 1

Choices in healthcare made when the demand exeeds the resources available

Question 2

What do a priority setting

Answer 2

not enough people time or money

Question 3

What types of rationing are there

Answer 3

Explicit in view of the public

and implicit behind the scenes

Question 4

What are the benefits of implicit over explicit

Answer 4

practical, no emtional consequences, bureaucratic and political effectiveness

Question 5

What are the benefits of explicit rationing

Answer 5

underlying ethical principles can be made explicit
guided by voices of many
informed democratic feedback may hep improve the decision

Question 6

What forms can rationing take

Answer 6

Denial
selection
deflection
deterrance
delay
dilution
termination

Question 7

At what levels are priorities set?

Answer 7

micro-individual
meso-hospital and individual institution
macro-system level

Question 8

What are the four components to priority setting

Answer 8

wants and needs
timing
ethics
economics

Question 9

What principals guide priority setting

Answer 9

Medicine= techincal efficiency
economics= allocative efficiency
politics
ethics

Question 10

What is cost minization and when can it be applied

Answer 10

use lower costing/generic drug but only if the outcome is the same

Question 11

How can cost effectiveness be compared when the outcomes are different

Answer 11

incremental cost effectiveness ratio

Ca-Cb/Ea-Eb

Question 12

How can effectiveness of a intervention be assessed

Answer 12

QUALY- takes one year of perfect life expectancy=1 QUALY

5 years at 80% quality=5x0.8=4 QUALYS

Question 13

Explain the law of diminishing returns

Answer 13

The one additional unit of input that tips the balance to non-beneficial

Question 14

What are marginal costs

Answer 14

The cost of that next unit of input or the benefit of the next unit of input

Question 15

What are opportunity costs

Answer 15

in investins resources in one way one other opporunity for benefit is lost somewhere else

Question 16

What is the cost of illness made up of

Answer 16

Direct costs- bus fare vaccine cost, nursing wage
indirect cost- heating the building, administrator time
Opportnunity costs- benefit lost elsewhere

Question 17

If there is no additional budget allocation what can be used to decide how the change can be implemented

Answer 17

Program Budgeting and marginal analysis works out where to invest and deinvest using opportunity and marginal costs

Question 18

What four rules exist in value-based decisions

Answer 18

Veracity
privacy
confidentiality
fidelity

Question 19

What influences guide a value based decision

Answer 19

right and wrong
what powerful professionals think
the greater good
what we have always done 
standard
needs in an emergancy