Healthcare Economics
Question1: Relationship between Efficiency and equity in healthcare
Efficiency and equity possess high political and ethical content for policies in healthcare. An efficient Healthcare sector is very crucial in the sense that it determines individuals’ health. At the centre of societal and individual wellbeing is, in most cases, is good health. Arguably wellbeing is synonymous to good health contrary to world health organization’s axiom that it is a necessary condition for it. Ostensibly, maximization of health is the main objective of the healthcare systems. For instance, in the UK, the National Health Service is responsible for improving mental and physical health. The NHS achieves this by securing the available resources. Equity is the act of distributing resources to those people in more need. In this case, equity in healthcare is providing essential healthcare services to a population that is in dire need of those services. For example, disabled, elderly, people suffering from chronic diseases and mentally ill require health services more as opposed to articulate, demanding and enabled consumers. On the contrary, efficiency is the appropriate utilization of resources. Efficiency ensures that patients are properly scanned, screened and medicated.
The health’s social gradient stipulates that low wealth results in low life expectancy. According to a diabetes report in the UK, the highest risks and complications of diabetes was dominant among the UK’s poorest population. Moreover, a research that was conducted in Hackney, East London indicated that older people with several chronic diseases exhibited psychological co-morbidities. Notably, some policies tend to inflict financial constraints on the poorest and sickest people in the society and hence widening the health divide. In contrast, programs such as shared care planning increase both efficiency and equity. Besides, there are various ways in which equity can be applied to the public health sphere—first, equal health outcomes. Second, Equal utilization of healthcare for equal need. Third, equal resources/expenditure. Fourth, equal costs.
Prioritization of health aims at achieving efficiency without compromising equity. From health market economists point of view, efficiency and equity are mutually exclusive. Nonetheless, this is not applicable to health systems. According to the 2000 World Health report, efficiency and equity as significant measures of a good healthcare system (Reidpath D et al., 2012,1-5). There exists no unanimous agreement on the development of a health policy that can produce maximum gains in health while fairly distributing the resources. According to Sassi et al. (2001), situations or conditions in which efficiency and equity outcomes could be improved by services. For example, In the UK, doctors get paid for every woman that get screened for cervical cancer. Despite these measures, the disadvantaged groups still record low participation rates. Sassi et al. argue that the cases of cervical cancer would be minimal are the payments could be channelled to general practitioners so as to achieve equal screening among all the socio-economic groups. In this case, efficiency was compromised due to the emphasis on equal access instead of equal outcomes.
References
Sassi, F., Le Grand, J. and Archard, L., 2001. Equity versus efficiency: a dilemma for the NHS: If the NHS is serious about equity, it must offer guidance when principles conflict.
Reidpath, D.D., Olafsdottir, A.E., Pokhrel, S. and Allotey, P., 2012, June. The fallacy of the equity-efficiency trade-off: rethinking the efficient health system. In BMC Public Health (Vol. 12, No. 1, pp. 1-5). BioMed Central.
Marmot, M. and Wilkinson, R. eds., 2005. Social determinants of health. OUP Oxford.
Question two: How rationing impact scarcity in healthcare
The issue of scares resources in healthcare is always a big challenge. For a long time now, the UK has tried to obtain a more rational allocation of healthcare resources. Assumedly, the maximum supply of healthcare facilities can be attained by measuring the objective healthcare needs. A need’s objective measurement will never determine the availability of healthcare services. The assumption that NHS could match the resources and needs has been proved to be a chimera. On the contrary, the available resources to the healthcare system depend upon complex socio-political systems. Apparently, no matter to what extent the healthcare facilities get expanded, they will eventually get depleted and still fail to satisfy the pool of unmet demands. Despite the increase in the number of doctors in England, there still exists more demand for doctors since they cannot meet all the patient’s demands. Arguably, for every patient that gets discharged from a hospital bed, there is another patient waiting to fill that bed.
It is in the public domain that healthcare services and facilities always be scarce. The decisions on how to solve or deal with these scares resources have been made public. The rationing process poses serious consequences to people’s quality of life and health. And for this reason, it involves key decisions. The decisions made are significant in the sense that they concern life and death. Rationing decisions should be based on facts that are associated with healthcare needs. Rationing proves to be the appropriate alternative to deal with the scarcity of healthcare resources. Instead of giving each person what he or she needs, a small portion is given to all. This means that the patients’ needs cannot be met optimally (Liss, 2006, 125-134). The rationing essence is intentional restriction. Secondly, rationing could be a better alternative when it becomes difficult to optimally meet the needs of a patient within a stipulated time frame. Healthcare rationing can be done in two main ways. First, pure rationing which entails no priority decisions. The second kind involves making priority decisions.
The Covid-19 situation is a perfect example of rationing of healthcare facilities. However, it’s worth noting that, even with the absence of a pandemic, healthcare workers sometimes get to ration the resources. For instance, UK hospitals have been overwhelmed with the covid-19 pandemic in the sense that, they are receiving so many infected patients who require ventilator services which at this stage are very few. In Italy, professional health organizations directed doctors to prioritize younger people to elderly people (Chung,2020). The US, on the other hand, is running out of ICU beds and ventilators and other medical resources. Summarily, rationing impact scarcity by at least sharing the few available resources to meet people’s needs but not optimally.
References
Liss, P.-E. (2006). Allocation of scarce resources in health care: values and concepts. Texto & Contexto – Enfermagem, 15(spe), pp.125–134.
Chung, J. (2020). Rationing Scarce Medical Resources | The Regulatory Review. [online] www.theregreview.org. Available at: https://www.theregreview.org/2020/05/23/rationing-scarce-medical-resources/ [Accessed 2 Jul. 2020].
Question three: Economic evaluation of the cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK using Drummond criteria.
HIV prevalence among men who have sex with men has been high in the UK and other high-income countries. Despite the application of ARVs, the cases have risen dramatically. For this reason, other approaches need to be incorporated to address the rising number of infections. Pre-exposure prophylaxis stands out to be the promising option in addressing the issue. This approach incorporates HIV negative people given the drug combination to reduce HIV infection risk. Whether used in an event-based manner or on a daily basis, PrEP has proved to be efficacious. There exist several underpinnings on whether the application of PrEP is cost-effective from a health care point of view and its impact on the budget. Therefore, the main objective of this paper is to conduct an economic evaluation on the cost-effectiveness of PrEP using the Drummond model. This paper will apply Drummond’s 10-point checklist to do the conduct an appraisal of the cost-effectiveness of the application of PrEP.
“Was a well-defined Question posed in Answerable form?”
The UK healthcare system is facing a big challenge in the rising number of HIV cases among men having sex with men. Despite the introduction and application of ARVs, HIV prevalence among men who have sex with men tends to be high. Therefore, there is a need for a different approach that would reduce the number of HIV cases among MSMs. The use of PrEP has been identified to be the best approach to address this issue. The study that was carried out by Cambino et al. did an examination of both the costs and effects of adopting the PrEP program. Moreover, the study by Cambino et al. involved comparison alternatives. In their research Cambino, compared two scenarios whereby in one scenario PrEP was available, and in the other scenario PrEP was not available. Besides, the viewpoint of the analysis was given, and it was given as the National Health Service of the UK, which is the provider and purchaser of healthcare.
“Was a Comprehensive Description of the Competing Alternatives Given?”
The authors did an excellent job in providing an overview of the current state of health in the UK regarding HIV prevalence among MSM. Notably, there was a possibility of other omitted alternatives.
“Was the Effectiveness of the Programme Established?”
The results of Cambino et al. were based on a dynamic individual-based simulation. This HIV synthesis model measures with men having sex with men UK’s HIV epidemic. Apparently, the work did not require any ethical approval. The main results were obtained through a probabilistic sensitivity analysis. Twenty-two key parameters were sampled in the process. The health benefit of PrEP was estimated by putting into consideration the combined parameters that contrived averted HIV infections. The effectiveness of the program was based on data from the study. It’s worth noting that no observational data were used in the study. The underlying assumption was that HIV testing behaviour, sexual behaviour and the possibility commencing the use of ARVs would be constant at the current levels. The main assumption in the scenario where pep was available was that men having sex with men were suitable for PrEP. However, they must have had the following; condomless anal sex in; HIV test at PrEP commencement and occupied an extra HIV test that is negative in the preceding year. The data effectiveness was from the 22 sampled parameters and 5965 simulations.
“Were all the important and relevant costs and consequences of each alternative measured.?”
Cambino et al. embraced a social perspective which is a standardized economic evaluation approach. Both the long term consequences and costs were considered in the study. The study also covered all the relevant viewpoints. The relevant viewpoint, in this case, is the UK National Health Service which is the purchaser of healthcare. PrEP introduction lowered the HIV cumulative costs. The operating costs and capital costs were also included.
“Were Costs and Consequences Measured Accurately in Appropriate Physical Units?”
From the study, there is little to suggest that some identified items were left out from the measurement. Drug costs, capital costs and all other relevant costs were included. However, fewer details are availed in the context of the actual quantity of resources that were used. Nonetheless, there is reference made in quantities in the tables in terms of predicted numbers of HIV patients. There were no circumstances recorded whereby the measurements were made difficult.
“Were costs and consequences valued credibly?”
The base year of the study was chosen to be 2019, and all costs were in sterling pounds. Each resource item’s unit is varied and presented in the analysis of
sensitivity. The outcomes’ valuation assumptions are appropriate and clear.
“Were costs and consequences adjusted for differential timing?”
Costs incurred in the subsequent years got discounted at a rate of 6 %. However, the study does not make any mentioning of discounting indirect costs and transfer payments. Moreover, there was no discounting of life-years in the base case; nonetheless, this assumption got tested in the analysis of sensitivity. The discounted rate applied lacked justification. The UK recommended rate is 6% per annum.
“Was an Incremental Analysis of Costs and Consequences of Alternatives Performed?”
In their main results, Cambino et al. reported an increase in the overall costs for twenty years and the incremental cost-effectiveness ratio takes forty years to reach less than 13,000 sterling pounds per QALY gained.
“Was Allowance Made for Uncertainty in the Estimates of Costs and Consequences?”
In recent years, improvements that have been made in the computing technology has realized testing of cost-effectiveness sensitivity to results to assumption’s variations that surround epidemiological and input cost variables. Cambino et a. carried out a rigorous and appropriate uncertainty and sensitivity analysis. Moreover, the study also considered the effect of the assumptions on the final results. Besides, the results were sensitive to value changes.
“Did the presentation and discussion of study results include all issues of concern to users?”
The discussion presented by the authors was in the context of existing literature and limitations. Extensive analysis of the uncertainty gives support to result’s robustness. Presentations of the key findings are done in a manner that policymakers can easily understand. Examining Cambino et al. study in the context of the guideline for economic evaluation appraisal gives the reader an insight into the methodological problems facing the analysis. The results were not compared to those of who had done an investigation on the same question because the research had not been done in the UK by anyone. Notably, the study did not explore the generalizability of the results.