Economic Evaluation in the National Health Service (NHS)

Economic Evaluation in the National Health Service (NHS) The National Health Service is built on the Benthams concept of utilitarianism of maximising utility for greatest number (Lockwood,1988), enabling risk sharing across the entire population by confronting moral hazard and adverse selection. This can be linked to the microeconomic theory of supply and demand (Frank, 1994). Supply and demand underlies the allocation of limited resources or commodities used to achieve maximum health output. In this situation, demand refers to both willingness and ability to pay, and supply is the willingness and ability of potential sellers to produce and sell a particular commodity (Schafermeyer, 2000). Consumers subject to their individual income constraints, maximise their individual utility through their purchasing of particular goods. As such, health in this respect has both aspects of an investment good and a consumption good. The demand for health care services is very different to that of food. Health, unlike other resources, cannot be traded over time. It is a derived demand, in which consumers have a demand for health but cannot directly purchase it (Ringel, 2002). Like a capital good, health is capable of depreciation over time and as such; its demand is a time-dependent variable, which changes with exogenous and endogenous factors. Therefore, one could suggest there is unlimited health care demand that will always exceed limited supply due to the overall burden of ill health being impossible to anticipate due to changing constantly. As such, health care in an important determinant of health but the demand for it is often unpredictable (timing, frequency, intensity, costs) and therefore, expensive. Markets favour consumers with purchasing power. The food industry is a free market, dictated by consumer choice and demand, the emergence of new suppliers and the exit of under performing suppliers. Within the food market, elasticity is driven by the premise of consumer sovereignty, in which consumers have information about every product, therefore can choose an enormous range of options and exactly how much of any given thing we want to purchase. In a free market, no one producer can manipulate the market price of a product. Producers are incentivised to satisfy consumer wants and produce efficiently to gain maximum profit. Economic theory suggests that under certain circumstances a free market promotes the optimal outcome for consumers and providers. As such, equilibrium in price and quantity are eventually met. While markets may be efficient, the allocation of resources by markets may not result in equity Do we have purchasing power as consumers in health care? In simple terms, we can predict when we will be hungry but we cannot predict when we are going to be ill and we know how to treat hunger but not all the eventualities of ill health. It is likely that without a national insurance system like the NHS an oligopolistic market would exist as there would be a few dominant sellers capable of influencing the overall market price of a commodity due to great market power.The universal NHS exists to meet this variable demand and ensure equity by providing a comprehensive, high quality service available on the basis of clinical need and not ability to pay; ensuring individuals arent victims of the market forces that could be derived from a market in which access to services is driven by the law of demand. It exists under a command market with no competition ensuring horizontal equity in distribution. In health care, consumers dont have the necessary information for driving a perfect market . To have perfect information they would need to know their current health status, prospective health status, available treatments and the cost of treatments. We rely upon doctors acting as agents (principal-agent relationship) or gatekeepers to assist in our decision making and to purchase healthcare based on their knowledge. In the Grossman Model based on a human capital approach to health (Grossman 1972; Grossman 2000) demand for health care is derived from the demand for health. In this model, it is recognised that consumers have imperfect information about their health and therefore may be subject to adverse selection problems. For a perfect market to exist within Health Care Services there is a need for prefect competition. For perfect competition to exist, asymmetry of information between consumers and producers should not exist, there should be uniformity in product and producers should be able to freely enter and exit the market. Rational purchasing decisions are often diff icult if not impossible to the non-medical population. Consumers are often unable to make an informed decision regarding whether treatment is required and, if so, which therapies are most effective. Markets in health care are not efficient, mainly because consumers do not have good information. In making resource decisions, allocation efficiency is also important. The concept of allocative efficiency takes account the efficiency with which outcomes are distributed among the community. Question 2 What are the disadvantages and advantages of using quality adjusted life years (QALYs) in economic evaluation? (800 words maximum) Within the National Health Service, according to Morris, Devlin and Parkin (2007), economic evaluation is used for the following reasons: To maximise the benefits from health care spending. To overcome regional variations in access. To contain costs and manage demand. To provide bargaining power with suppliers of health care products. QALYs are a type of health status index, based on population-level information that measure health gain (Spencer, 2003 p.1) to allow for economic evaluation of different health interventions. A single QALY is the arithmetic product of life expectancy, weighted by a measure of the quality (utility) of the remaining life-years to reach a single index value (Prieto and Sacristà ¡n, 2003). The utility value is 0 for dead and values one year of perfect-health life expectancy to be equal to one. These values are derived from scales, namely, the rating scale; time trade-off; or standard gamble. Each is subject to forms of bias. The QALY model offers consistency and limits budgetary waste, allowing for the greatest good to be achieved for the greatest number, so called distributive justice. It also allows for direct comparison of interventions in a common currency regardless of clinical discipline. This is because the cost per QALY does not confer the price of treatment but the price of the outcome that results, may that be in years or quality gained or lost. Phillips and Thompson (2001) summarise this as an expensive treatment may have a low cost per QALY if it brings significant benefit to patients; likewise, a cheaper treatment may have a high cost per QALY if the degree of benefit is relatively low. There are however specific criticisms held as to the generalisability of this model, the lack of consideration for baseline health status and whether QALYs perpetuates the issue of health inequalities (Wagstaff, 2002). The use of QALYs implicitly assumes that there are no other objectives to health care than health maximization. QALYs are considerably crude measurements, leaving vulnerable the question what exactly constituted the quality for which life years are adjusted. The utility measurement instruments each hold inherent bias as they are subjective aggregation of values. Individuals do not place the same value on each year of life. As such, the QALY model is inherently flawed as a health state utility of 0.6 is the same as three extra years of life at a health state utility of 0.2. As such, concerns have been expressed about the appropriateness of using QALYs calculations to inform resource allocation decisions (Dolan et al, 2008) as they are attempting to make subjective conce pts explicit numerically when there really is no consensus, leaving ambiguity in assessing overall improvement or detriment in health. Criticism has been expressed about the discriminatory aspects of the QALY model. The model favours those with more treatable conditions and those with greater potentials for health- be it in terms of functioning or longevity (Nord et al, 2009). Question 3 Outline the main methods to remunerate general practitioners (GPs) in the United Kingdom. (300 words maximum) GPs are self-employed providers, which under the 2004 GMC negotiated contract are paid by mixed payment remuneration, consisting of salary based on weighted capitation, fixed allowances, QOF and fee for service. Individual GP practices are allotted a practice income under the contract, from which expenses and staffing costs are funded. This payment, representing the largest part of their income, is a capitation fee per enrolled patient adjusted for age, gender, morbidity and mortality, with additional fixed allowances for maintaining particular services. GPs working in underserved geographic areas receive additional payments. Distribution to individual GPs within a practice is dependent upon seniority, practice efficiency and maintenance of operational costs through cost containment. GPs can also receive additional payments based on the quality of services provided in designated areas such as child health, maternity, family planning, and chronic diseases as part of a quality enhancin g framework (DH, 2004). The Quality and Outcomes Framework (QOF) is a voluntary, evidence-based framework spanning four domains: clinical, organisational, patient experience and additional services (DH, 2003). GPs are challenge to meet a range of evidence-based indicators within these domains from which they can accumulate points based on the breadth and depth of quality. As a result, payments are awarded according to the level of achievement. Practices receive about  £125 per point for an average sized practice with a maximum of 1000 points available to them. QOF is often revised to reflect changing population priorities, clinical advancements and best evidence to remain a pragmatic funding model. Thirdly, practices can enter into so called Enhanced Service agreements, based on the fee for service model. In Enhanced Service agreements, payments are awarded for meeting targeted requirements, such as flu and childhood immunisations and providing other specific services. ii) Compare and contrast 2 of these methods outlining advantages and disadvantages of each. (300 words maximum) Different financial incentives given to GPs might affect their behaviour and treatments plans for individual patients. Fees for service compensation is awarded based on a service being given to an individual patient. Care is clearly linked to payment and each service that is delivered has a specific payment rate. It has been argued that such a system of compensation induces GPs to put quantity, over quality of care in a bid to get increasing numbers of patients through their practice door and allows for unnecessary, potentially more lucrative, treatments to be performed at a financial benefit to the GP. This compares quite dramatically to the capitation system, which remunerates practices based on the population demography, regardless of the health status of the population. This means GPs have better budgeting capabilities, as each payment is fixed regardless of case mix meaning it is an equitable system for all patients. Capitation removes the need for GPs to see a high volume of patients within an allotted time frame but places incentives upon general practioners to enrol large numbers within their practice. As such, Capitation comes with the added risk of the potential to have a difficult case-mix due to increased numbers and allows for cream skimming to take place in which GPs exercise the potential to choose patients that are easier to care for, leading to health inequalities in certain demographics, i.e. the elderly. Outline the equity implication of patient co-payments for primary care services. (300 words maximum) Concern with equity implies the availability of some goods, including health care, should not be based, or based solely, on willingness to pay. Indeed, equity is an ethical concept built on the principle of distributive justice. In health, it is considered to be the absence of systematic disparities in health between groups with different levels of underlying social advantage/ disadvantage (Braveman, 2003, p1). Co-payments are flat fees or means tested payments, based on the willingness to pay model that a patient pays for a named health care service, such as a GP visit, dental treatment or prescription. Basing health care treatments on being able to pay is contentious. Co-payments have the potential to widen the equality gap by discouraging or restricting people from seeking important treatments or forcing individuals from lower socio-economic groups into making decisions about their health care based on price not their need. Equity assumes equal utilisation (use) for equal need. References Braveman P Gruskin S. (2003) Deà ¯Ã‚ ¬Ã‚ ning equity in health. Journal of Epidemiology and Community Health 57 pp. 254-58 Department of Health (2003) Investing in General Practice; The New General Medical Services Contract, Department of Health, London Department of Health (2004) Updated version of the QOF guidance and evidence base, Department of Health: London; 2004. Dolan, P (2008). Developing methods that really do value the Q in the QALY. Health Economics, Policy Law;3 pp.69-77. Dolan P. Kahneman D. (2008). Interpretations of utility and their implications for the valuation of health. Economic Journal; 118 pp. 215-234 Frank, R (1994): Microeconomics and Behavior. New York: W.W. Norton Company Goddard M. Smith p (2003) Equity of access to health care services: Theory and evidence from the UK, Social Science Medicine 53 (9) pp. 1149-1162 Grossman, Michael (1972a), The Demand for Health-A theoretical and Empirical Investigation. New York: National Bureau of Economic Research. Grossman, M. (1972b), On the Concept of Health Capital and the Demand for Health, The Journal of Political Economy, 80 (2) pp. 223-255. Grossman, Michael. (2000), The Human Capital Model, in Handbook of Health Economics, 1, pp. 347-408 Lockwood, M. (1988). Quality of Life and Resource Allocation. Royal Institute of Philosophy Supplement, 23, pp 33-55 Morris S, Devlin N, Parkin D.  (2007) Economic analysis in health care. John Wiley Sons, Ltd. Pinto-Prades, JL. Loomes, G. Brey, R. (2009)Trying to estimate a monetary value for the QALY ,Journal of Health Economics, 28 (3) pp. 553-562 Phillips, C. Thompson, G. (2001) What is a QALY? [online] at: http://www.evidence-based-medicine.co.uk/ebmfiles/WhatisaQALY.pdf Prieto, L Sacristà ¡n, J.A. (2003) Problems and solutions in calculating quality-adjusted life years (QALYs) Health Quality Life Outcomes; 1 pp. 80 Ringel, J ( 2002) The elasticity of demand for health care: a review of the literature and its application to the military health system, United States. Department of Defense, National Defense Research Institute (U.S.) Schafermeyer KW (2000) Health Economics I: Basic Economic Principles, Journal of Managed Care Pharmacy 43-50 Spencer, A. (2003) A test of the QALY model when health varies over time, Social Science Medicine; 57, (9) pp. 1697-1706 Wagstaff, A (2002) Inequality aversion, health inequalities and health achievement,  Journal of Health Economics, 21(4) 627-641

The Perception of Happiness in Families :: Happiness Essays

Guccione begins by discussing the uninteresting perception people have with the lives of happy families. Using a quote from Tolstoy, Guccione shares past data of how people are taught to believe that all happy families are alike, while happy families share a uniqueness through their melange of misery. This discussion prepares you for her thesis, which explains how happy families struggle and work for the lives they graciously enjoy. Her thesis is marked by examples of myths, which she dismisses through her research. Successful families, according to her research, must develop skills in negotiating and coping. Guccione also mentions that not all happy families are alike. In fact, each is happy in its own way. She stresses how successful families earn their happiness and that it is not simply known to them. There were three sections of the body in Guccione's essay. The first part of the body discussed the notion of boundaries among families. Balance was another key term and she uses the living call as an example: "Families must be strong enough to allow integrity and and interaction within, yet be permeable to the outside." Guccione's research also led her to the importance of family members feeling that they are an intimate part of a group. She stresses that a frequently encountered problem is families where no one belongs, "where people come and go" as she puts it. Guccione then takes you into the life of a woman, Peg, who now lives an extremely happy life with her family. Previously, Peg had severe problems with her family and was unhappy. However, by creating a balance, she was able to negotiate and cope with the problem. The section closes with Peg, the difficulties she lived and the ones yet to come. Overall, she expresses relief in knowing that hard work leads to happiness. The second part of the body enters the world of single parents, how they cope with life in order to reach true happiness. Guccione begins by showing her research of how happy families posses a mutual thread; "the ability to maintain the balance between individual freedom and the need people have to belong to a group." She also encourages families to help each individual member reach their own potential. Guccione then tells the tale of Marie, a single mother raising her two boys, aged 11 and 13.

Ho Chi Minh City Essay

Trung nguyen is the most famous coffee brand in Vietnam. It was created in 1996 by Mr. D? ng Le Nguyen Vu. During student life in medical school of Tay Nguyen, Mr. D? ng had a question about coffee farmers’ life. Although the price of a cup of coffee wasn’t cheap, but why, farmers were still poor. This question encouraged him to find the answers. He and his company suffered from many accidents, but they kept on trying. Those experiences brought them a good background for opening more shops and expanding their business widely. And in early 2004, they introduced G7 to the customers. This step turned Trung Nguyen history to the new page, they became the biggest and the most famous firm selling high-quality coffee powder. II. Strategy Trung Nguyen first opened their first coffee shop in Ho Chi Minh City in 1998 and received some positive feedbacks. In 2001 they had built over thousands coffee shops all over Vietnam and became top-rated brand in Vietnamese coffee industry. They did Franchising, the step which was different from all other Vietnamese firm, they were the first. After 5 years, Trung Nguyen not only could gain the trust, the belief of Vietnamese customers but also customers in other countries like Singapore, Japan, Cambodia, etc. In 2006, Trung Nguyen invested and built the biggest high-quality G7mart system of stores for selling products. In June 2012, Trung Nguyen created the new strategy. That was creating the string of quick shops, which allows customers to choose some various kinds of coffee beans and the owner of the shop will mix them together for making the customers’ own styles. The evidence for the development of this strategy is the profit which grows 15% per week Trung Nguyen’s customers are not only the elder, the people who understand clearly about coffee but also, they have products for the young, who begin drinking coffee like student, teenager, etc. III. Revenue-Potential Growth. Although the economics go down, Trung Nguyen still makes profit, and improves themselve powerfully. In 2011, their revenue and production improve up to 151%, and the first six months in 2012, they gain up to 178% compared with the same time in 2011. The biggest evolution of Trung Nguyen is their G7 powder became the leader of coffee powder in Vietnam at the rate 37. 8% In the near future, Mr. D? ng plans to join the world stock market and in the next 10 years, he tries to invest more than 800 million USD to build new factories and some additional options.

Society’s Influence on Young Girls Anorexia Nervosa and...

Every generation has a set of values that they believe make a person beautiful. In the 1940’s and 50’s it was considered beautiful to be a voluptuous woman. A woman with a large chest and full hips was the ideal woman, such as Marylyn Monroe. The difference between then and now is, young women could escape this image if need be. Today it is impossible to ignore the stick thin super models on bill boards, TV, and in magazines. The influence of society on teenagers is so much that men actually expect a woman to be that stick thin model or they are considered â€Å"fat†, â€Å"tubby†, etc. The average fashion model is 59 to 6 tall. The average American woman is 5 4 tall. The average fashion model weighs 110-118 pounds. The average American woman†¦show more content†¦Symptoms of someone who has this disease include: feeling chubby even when people say that they are not, scared of gaining weight, if they lie about how much they eat or even hide things about their eating habits, if their family and friends are worried about how they look or how they eat. Also if they experience tremendous weight loss, if they diet, exercise, or purge when feeling bad about themselves. Anorexia is not a way to control your weight but a way to control your feelings or your life. People with anorexia think self-esteem is based on body weight and how thin you look compared to a person who does not have anorexia and has self-esteem based on more than just body weight and image. A healthy person who diets does it in a healthy way, but anorexic people do it in a way that is not healthy all they want is to be thinner, not healthier People can recover from anorexia with the proper treatment and support of others. You need to first gain back your health and then your self-confidence. (Melinda Smith) People who have anorexia or another eating disorder and go without treatment have a 20% higher chance of dying than people who get treatment. People who receive treatment have a lower percentage of death due to anorexia, 2-3%. Statistics show that 60% of people that get treatment make a full recovery while about 20% make a partial recovery, and 20% stay underweight at a dangerous level. Anorexia can cause a number ofShow MoreRelated Anorexia Nervosa and Bulimia Nervosa Essay1163 Words   |  5 Pagescan suffer. But eating disorders, such as Bulimia Nervosa or Anorexia Nervosa, are generally found in adolescent girls and young women. Anorexia Nervosa affects less than one percent of adolescent girls and young women, whereas, Bulimia Nervosa affects two percent. Approximately five percent of people with Anorexia are male. 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