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Rationing Health Service – Priority Setting
represent the views of his/her organisations on the topic discussed.
Journal Presentation Article: Rationing Hospital Services in HK: Priority
setting by clinicians using Delphi method
Dr W C Ip Journal: Health Services Management Research Grand Round in Administrative Medicine Author: Peter Yuen, Derek Gould, MY Cheng 25 May 2002 Book: Rationing in the NHS: Principles & Pragmatism Authurs: Bill New & Julian Le Grand Rationing Hospital Services in HK Rationing Health Service – Priority Setting New Zealand’s Experience
Article: ‘Reforming New Zealand’s Health Care System’,
¾ Purpose: Identify interventions that should
Nicola North, Int’l Journal of Public Administration,
Rationing Health Service – Priority Setting Rationing Health Service – Priority Setting Delphi Method
Based on pooled judgement Participants are anonymous to each other make responses/judgement without coming
Final List See Words file: “Prioritization – Final List” Interventions receiving high Clinical Oncology scores from the final Delphi round
• Surgical scar / prophylactic irradiation
Ear, Nose and Throat Medicine Obstetrics & Gynaecology
• Non-urgent cases at A&E / all treatments
• Special brand name instead of generic
• Termination of Pregnancy without medical
Ophthalmology Orthopaedics & Traumatology
• Refractive error / LASIK or refractive
Paediatrics
• Cord blood banking for possible future use
• Cutaneous acquired lesion (e.g. tattoo) /
Observations Conclusions High Score Interventions:
• Diverse views amongst COSs regarding effectiveness of certain interventions
Prevention & Early Detection Services Patients’ choices: e.g. cosmetic surgery, child delivery by
• Diverse reasons (other than cost-effectiveness) for doctors, sex-related treatments, etc. determining which intervention to charge
Small no. in the final list: 127 items Final List Items are NOT the most expensive ones
• Result of the exercise is not applicable /high volume ones – cost recovery insignificant.
Few items with “questionable effectiveness”
• The procedure (Delphi method) transparency and
Many are based on “Other reasons” participation
3 out of 9 items on the PPMI list received +ve score Critiques on the Exercise Critiques on the Exercise - Continue
• Representativeness of COSs (no. ; specialties) • COSs allowed to prioritise interventions of other
• The initial lists – how was it made up? specialities.
• Societal value not reflected
• COSs are already doing prioritization on their own services though implicitly – already biased
• Exclusion List vs. Inclusion List ?
• Other interested parties not included
• Exclusion approach vs. Zero-based prioritisation
• No specific criteria for “cost-effectiveness” • No specific criteria for “other reasons” Rationing Health Service – Priority Setting New Zealand’s Experience: Continue New Zealand’s Experience
• 1990s: Aimed to draw up a list of “core service”
• Organised “Consensus Conferences” to consult that all New Zealanders are entitled to the Public and Health Professional within a reasonabl period of time
• To agree on effectiveness or treatment for high
• Health Services outside the list are to be volume or high cost procedures purchased privately
• A statutory committee put in charge New Zealand’s Experience: Continue Rationing Health Service – Priority Setting Criteria for Rational Rationing Failed to produce a “list” Maximum social benefit: cost-effectiveness, societal Recommended that existing services in public sector were the “De Facto Core” General consensus through Democratic process: Endorsed service purchasing principles: Value for
money; community values; quality over quantity, primary
care over high-technology; community care over hospital
Systematic & Formal methodology: to determine “list” Developed Guidelines regarding health priorities: Consistent, non-discretionary application
e.g. substance abuse; emergency ambulance service,
Explicit : Listing in clear terms what are/are not provided Rationing Health Service Recommendations: Incremental Approach (These are what HA is doing)
• Expand PPMI list
• Gradually introduce full/partial cost recovery measures
• Contain access
• Any more ?
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