ICER (incremental cost-effectiveness ratio)
= cost/effects
QALY
= ife years weighted with health-related quality of life (HRQoL in terms of ‘utility’)
Instrument that measures the utility consists of 5 dimensions
(QALY questionaire EQ-5D)
- mobility
- self-care
- usual activities
- pain & discomfort
- anxiety & depression
Value sets
Utilities based on value sets = the table we used earlier.
Value sets: members of the general public value health using quality of life measurement instruments.
Differences between adults and children; that means that adults and children with the same disease, have different utility levels. To reflect societal values in utilities.
Weighting of QALYs is an example of explicit rationing?
- Transparent
- Retraceable
- Consistency between decisions
Weighting within QALYs is an example of implicit rationing
- Less transparent, because you weight utility without prioritising
- Comparable across diseases
- Defining QoL for different age groups
Which preference to use?
- Adult versus child preferences
o How we determine child health is to ask adults how they value child health - Public versus patient preferences
o Should we ask the public or the patients? Who do we listen to
o Public because we are the taxpayer, so we have the right to determine and prioritise what to do with our money
o Patients because they know best how it is to live with a certain illness and how to adapt
Each option is a moral dilemma in itself, whether we decide to listen to children or adults or public or the patients. This is an ongoing discussion within and between multiple countries. For example, in the Netherlands we feel that children should be prioritised, but in other countries they prioritise the elderly.
Social Care
= support or care to individuals with long-term or permanent functional impairments due to aging, mental or physicial disabilities
Aim social care
= to support individuals to live as independently as possible to their own homes while maintaining quality of life (care, not cure. provided in user’s home/community)
Support types
- home care and personal support
- informal caregiver support
- self-directed support
- practical support
Social Support Act 2015
- decentralization policy introduced in 2015
goals:
- arrange care according to local demand and need
- increase social involvement in the care for elderly/dependent
- implicitly: lower expenditures
Define physical and mental health
= health is a state of complete physicial, mental and social well-being and not merely the absence of disease or infirmity
Cultural values in social care resource allocation
- living arrangements (multi- or unigenerational households)
- gender relations (more expected from daughters and wifes)
- employment
- filial piety/family obligation and caregiver responsibility
- stigma associated with asking for help
- shame or guilt associated with not caring for a relative
Cultural values Scandinavian
universal access to social care, provided independent of means and financed through general taxation. Unwilling to accept health inequalities.
Primary value: solidarity and citizenship
Cultural values USA
no universal access to social care;
Primary value: individual rights»_space;> social rights
Cultural Values Italy and Spain
emphasis on informal care
Primary value: tradition of the family
Cultural Values China
three nos policy
Primary value: filial piety
Take off Social Care
Social care resource allocation takes place on multiple decision levels, and various stakeholders are involved in the process.
There is no such thing as an enforceable right to social care, but access to social care can be derived from human rights.
Cultural values have a strong influence on the trade-offs made in resource allocation on social care, especially the role of family members in caregiving determines the quantity of formal care.
Social care policy in the Netherlands has justice implications.
