1.1 overview of course and basic principles (t)

954 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
954
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
12
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

1.1 overview of course and basic principles (t)

  1. 1. Overview of workshop and basic principles Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 1
  2. 2. Spending on health care in Canada$170 B in total health care spending in 2008on average about $5170 per person Canada ranked in top 5 of OECD countries 30% after inflation increase since 1993 Greatest increases in drugs $37 billion in spent in 1984translates to 10.7% of GDP and in many provincesover 40% of provincial expenditure Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 2
  3. 3. What are we getting for this spending?90% of people who used the system in 2007 ratedthe overall quality of the care they received as goodor better88% of Canadians rate their personal health as goodor very good2008 OECD health database Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 3
  4. 4. Yet, there are issuesAllocation of health care funds according to definedpopulations is a global phenomenonBasic notion within health authorities is that of alimited funding envelope Not enough resources to meet all needsAlso, 72% of Canadians believe our system requireseither fundamental change or a complete overhaul Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 4
  5. 5. In summarySome issues with our healthcare system:widespread perception amongst decisionmakers that there are not enough resourcesand amongst the public that major changesare neededThose two issues relate directly to resourceallocation and priority setting i.e. there areissues with resource allocation and prioritysetting Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 5
  6. 6. The goal in resource allocationDecision-makers need to determine: what health care services to provide for whom to provide services how to provide services where services should be provided… in order to meet local and/ or system levelobjectives including access, health gain… Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 6
  7. 7. How is that typically done?Resource allocation based on: Historical patterns with incremental adjustment Politics and the ‘squeaky wheel’ Needs assessment Core services economic evaluation (limited) Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 7
  8. 8. Historical allocationFunding based on last year’s budget with someadjustments No mechanism for maximizing benefit Continual growth in regional budgets Process for funding new proposals unclear Safe, can take less time Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 8
  9. 9. Politics and the ‘squeaky wheel’ Typically guides the ‘adjustments’ associated with the historical approach Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 9
  10. 10. Needs assessment (1)Define need and measure the met and unmet needs of a given population Common approach for setting priorities Useful in highlighting gap but not for priority setting ‘Need’ itself is value laden and will change as resource availability changes If unmet need, then allocate resource that way May not be enough resources… opportunity cost Costs and benefits often not considered in tandem Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 10
  11. 11. Needs assessment (2)Epidemiological needs assessment withdiseases ranked based on prevalence Effectiveness of interventions not considered Implies that services must be provided to meet all needs but fails to recognize scarcity Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 11
  12. 12. Core ServicesDefine a set of core services and only publicly fundthose services on the list New Zealand & Netherlands but problems in practice: what is ‘medically necessary’? Items ‘out’ may provide more benefit per dollar spent for some patients then other ‘in’ items As those that are ‘out’ are out, cannot shift resources from the ‘in’ items to the ‘out’ items… maximizing benefit overall unlikely due to margin being ignored Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 12
  13. 13. Economic evaluation (1)Comparison of two or more interventions or serviceson the basis of costs and benefitsCost-effectiveness, cost-utility, cost-benefitOpportunity cost: benefit gained from one servicemore or less than benefit from alternative uses ofresourcesBenefit: life years gained, QALYs, common currency Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 13
  14. 14. Economic Evaluation (2)Important tool but rarely provides the answer Other criteria in decision-makingTime and cost of studies… feasibility issueIncremental cost-effectiveness ratio (ICER) Low cost per unit of benefit ‘cost effective’ Incremental resources required, budget impacted elsewhere, opportunity costs ignored Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 14
  15. 15. QALY league tablesRanking procedures based on marginal cost perQALY gained (Oregon model)To produce more QALYs, items higher on list donein lieu of lower items Assumptions underlying ratios not considered Is QALY maximization really the end goal? List based approach: opportunity cost and the margin again ignored Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 15
  16. 16. How do decision makers feel about these methods?Surveys in various countries have reported feelings ofunease around priority setting United Kingdom (late 1990s) Australia (2003) Canada (late 1990s, 2004, 2005)• Often ad hoc and inconsistent approaches• Concerns about fairness and stakeholder impact Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 16
  17. 17. What is Required?A pragmatic decision-making approach that….– Aligns resources strategically with system goals and community needs– Leads to publicly defensible decisions based on available evidence and community values– Facilitates stakeholder engagement around improving benefit with limited resources– Supports the public accountability of health care decision-makersHow do we move in this direction?This is what this workshop is about Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 17
  18. 18. Workshop overview- key areas coveredKey principles underpinning a pragmatic approach to resourceallocation decision-makingHow to address values in the context of priority settingMethods for priority setting- specifically Program Budgeting andMarginal Analysis (PBMA)Economic evaluationSuccess factorsCase studies Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 18
  19. 19. Learning objectivesKnowledge on commonly used approaches to prioritysetting by health care decision makers both withinCanada and elsewherePractical steps for resource allocation priority setting,including generating and applying decision makingcriteria, based on the implementation of PBMAUnderstanding how economic evaluation can be usedalongside of other types of evidence to inform realworld health care priority setting Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 19
  20. 20. Learning objectives (2)Knowledge of individual and organizational successfactors related to improving priority setting andresource allocation practicesBasics of designing a process for resource allocationpriority setting in a health organization Craig Mitton & Francois Dionne | Priority Setting & Resource Allocation | 20

×