Transcription: Medical Ethics 6 - Resource Allocation QALY & Needs Based Model - YouTube

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00:00:00
Hello, my name is dr.

heart Pinto and today we're going to be talking about medical ethics, and the topic for today will be resource allocation, quality, adjusted life years and the needs based model.
So what is a quali is uses.
A concept of resource allocation.



00:00:22

A quality adjusted life year is a measure of the value of health outcomes.

00:00:26
So a year of life in perfect health is given a value of one and a year of one healthy life is given a value of less than one, which may be 0.
5 0.

3, etc.
A healthcare system is therefore one which maximizes quality adjusted life years and provides the most benefits of patients.
So what about the cost-effectiveness of quality adjusted life years? It's the utilitarian stance of maximizing healthcare with the resources that are available.


00:01:06
The most efficient healthcare system that exists is one where the cost per quality adjusted life year is low.

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Therefore, we can maximize the number of quality adjusted life years per the pound or per the dollar okay.
So why should we use qualities the maximum benefit for public? With the finances that are made available, therefore, it's maximizing the healthcare budget.

Not only does it promote health, but it also promotes the quality and quantity of it and how it influences patients lives.
But what are the negatives of quality just in life years against those with expensive health care problems? Let's look at some examples.
60 year-old patient with a major burn may require a prolonged stay in intensive care and repeated surgeries in these patients.

The total cost of care may enter the hundreds of thousands, and the patient may only live for another 10 years, for example.
Therefore, the cost per additional year of health that he has gained is very high in real terms.
That can mean that there's little benefit for society as a whole, but it provides the maximum benefit for the individual in need, and that's the important point amount of financial resources we can provide smoking.

Cessation advice to tens of thousands of patients is maximum benefit for society, and the cost of the quali is low point two: it's an unjust method of service allocation to patients, for example, requiring the same treatment for a community-acquired pneumonia.
If we look at patient a their fitting well and patient B has other comorbidities such as COPD congestive, cardiac failure, ischemic heart disease.

00:03:25
If we use qualities for our resource allocation, we would favor the treatment of patient a.

But if we consider our first principles, principle of justice states that both patients should have equal access to treatment.
Is it fair for the patient? Who's got all the medical conditions to not receive the appropriate treatment? Just because the other person we'll have a higher value of healthy years, gained okay.
Well, if we're discriminating against patients, who've got lots of comorbidities.

The elderly population are more likely to have these conditions and when they receive treatment, they're not gon na gain a hundred percent healthy life year.
Their value of their life gained will be less than one, and so should they not have received treatment as well.

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In these circumstances, we see that qualies favor those people who are younger and healthier Qualys themselves, don't specifically discriminate against age.


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You may have a ten-year-old as well who has a condition that would significantly shorten their life expectancy.
In these circumstances, this young child would have the same discrimination as those patients who are elderly with multiple comorbidities, as they cannot gain a hundred percent healthy life, even after their treatment.

00:05:09
Let's put in another way a seventy-year-old marathon runner with no medical concerns whatsoever may go on to live for another 10 or 20 years in this patient.

You would have a greater potential for quality of life years gained.

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So is it just to provide treatment for this patient as it provides maximum societal benefit compared to treating a young child? Who has many medical comorbidities? Who may not live very long? Another way to look at it? In contrast, equalities would be.
Should we be giving preference to young people as elderly have already lived their life? Is that the right question to look at probably now the second method of resource allocation is something called the needs based model in this case, it's based upon the concept that resources should be allocated to those patients who are most in need, ie, it prioritizes the most Sick, so that patient, that we've discussed with the significant burn injury who is elderly, he should justify having the treatment and also that young child that we discussed, who had a significant medical condition that was shortening his life.


00:06:28
We should still treat him because he's in need reality.
Rational citizens would wish for those who are worst off in society to have the maximal well-being, whilst in principle this is a great idea.

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We don't have infinite resources and it doesn't always provide for society as a whole.


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For example, should we spend all our budget on treating one single burn patient, or could we treat a thousand patients with pre malignant skin lesions? We know that using the needs-based model, whilst it's more generally accepted by the public, provides a less efficient allocation of healthcare resources and it provides increased costs to healthcare.
So if we enter a system were only patients who are most in need are being treated, we will only get patients who access healthcare well, a life-threatening illness occurs.

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This can be due to neglect of a chronic disease, for example angina, which then becomes a myocardial infarction, which potentially could have been prevented.


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Had we allocated resources to the management of those less in need who have chronic disease? So, in a way, the needs model isn't perfect: either.
Okay, let's summarize what we've reviewed so qualies or quality adjusted life years are a method of maximizing efficiency of the resource allocation.


00:00:22

It essentially gives us the most bang for our buck.

It's a utilitarian concept.
It provides a resource allocation which is best for society, but not necessarily for the individual and because it's looking at healthy life years gained, it can discriminate against elderly patients and those who require the most help.
The alternative model, the needs model, provides patients most in need.

With the treatment that they require, it is a less efficient method of resource allocation and you get less bang for your buck and there's also associated reduction in resource allocation to those with chronic disease.

00:09:11
Thank you for listening to this lecture.
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