Microsoft powerpoint - presentation02(dr w c ip 25 may 02)

* This presentation is prepared by the author in one’s personal capacity for the purpose of academic exchange and does not 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
ƒ Based on pooled judgementƒ Participants are anonymous to each other ƒ 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
ƒ Prevention & Early Detection Services
ƒ 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
ƒ Small no. in the final list: 127 items
ƒ Final List Items are NOT the most expensive ones
• Result of the exercise is not applicable
/high volume ones – cost recovery insignificant.
ƒ Few items with “questionable effectiveness”
• The procedure (Delphi method) transparency and
ƒ Many are based on “Other reasons”
participation
ƒ 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 ?

Source: http://www.hkccm.org.hk/Presentations/Presentation02DrWCIp25May02.pdf