Wednesday, September 25, 2013

How would you choose? Setting Health Priorities

This week in my Global Health and Social Policy (GHSP) module we had a class about health economics. What is health economics? In a SUPER broad sense from what I understand it is a branch of economics that tries to evaluate the health system and health care in terms of its functions and resources and its efficiency and/or effectiveness. Health economist try to understand "why" resources are allocated one way or the other. But my classmates are welcome to chip in here! The discussion went on to discuss things like why is the health system regulated, methods of economics and other things. 

Anyway, to bring the point home, we did an exercise that I wanted to share.

We were proposed the following scenario:
"You are a member of the Wearington-on-Sea Health Commission, deciding on purchasing priorities for the current financial year. A survey had already identified the health care needs of the local population - 400 people require treatment in the form of 10 different primary and secondary care interventions. Interventions and number are displayed in the Table below, as are the prices being charged by local providers and the total cost of each intervention."

Priorities the list for purchasing, in order of importance. You can make up the criteria for importance. Currently you have a budget of 377,800, which ironically is the same amount of the total cost of all of the operations! YEA

 No. of patients                                    Demand (Patients)    Price (£ - Pounds)        Total Price (£)

Hip Replacement502,040102,000
Hernia Treatment5028014,000
Treatment for bilateral prominent ears301,46043,800
Coronary artery bypass graft (2 vessel)107,10071,00
GP advice to quit smoking10012012,000
Female sterilization302407,200
Carpal tunnel (wrist) surgery251403,500
Cataract treatment401,00040,000
Double heart valve replacement513,50067,500
Treatment for varicose veins6028016,800
                                                  Total:         400                                                    377,800

Ok, not so hard, right. Since you had enough money to cover all procedures, the only decision was how you prioritised. So how did you prioritize? I prioritized by the severity of the condition. I can post my list, if someone wants to see it. My group and I were on the same page for the most part except on the issue of "GP advice to quit smoking". I felt it was a low priority and they felt like as a preventative measure (if used population health in the long run would be better) and due to the high demand it was higher. My personal feelings about smoking is that it is a choice, so it held less of a priority compared to life threatening issues or family planning (but higher than cosmetic surgery). But I also think it depends on the type of country we are talking about, high income vs low income, also what is involved in this advise/intervention (because if it is just advise, why does it cost so much!?).

NOW, here is when it gets hard, your budget just got cut (OH NO!) and you only have 250,000 in your budget, now how would you prioritise? Would you redistribute or re-think your earlier ranking? I for the most part stuck to my previous ranking, keeping the more life-treatening issues as priority, even though they cost more. For my group we were still debating the issue by the time we were supposed to have chosen. With the exception of me, my group wanted to look at prioritising the surgeries that would improve the quality of life for the many (hip replacement ext.) and cut the more expensive surgeries for the few (the heart surgeries). It was such an interesting debate! We also couldn't agree over the the issue of female sterilization?

 It was also really interesting to see how other groups approached the issue. Some groups choose to redistribute the money among different operations or they were going to negotiate down the prices using other methods. Super smart! What many of our questions came down to was circumstance - such as how old were the people getting heart surgery? If they were 90, are we going to really spend that money? OR in terms of the female sterilization issue, are there other forms of birth control available (IUD, birth control exc.)? Every answer, lead to more questions. It really showed how complex these issues are.

For me this exercise got me really thinking about what goes into health care planning and resource allocations. It left me with many questions but the main one is below.

How do we choose between extending a few peoples lives or improving the quality of life for many? Which one is better? How does one choose? Who SHOULD chooses? 

Anyway, this is just a bit of insight into what one of our classes is like. I like that we do these excersises, they make me think and bring up questions and critisisms I never would have considered.
Haha you want to know something that is funny? I am almost sure that they tackled some issues like this on Greys Anatomy once! :)

Sorry this was so long! But here is something to make you smile....

Copyright: LINK

Ps. For copyright issues, I am citing the exercise discussed above:
Tolley, Keith, and David Whynes. "The Priority-setting Exercise: An Instrument for Training in Health Care Resource Allocation." Medical Teacher 17.4 (1995): 391. Print.


TheGoldenGoddess said...

I wouldn't want to make the decision, but if duty called, I'd choose to improve the quality of life for the many.

I, too, would have been emotionally drained at the end of the class!

Great job describing it for us....

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