Health Authorities and Trusts - Research Paper Example

 Health Authorities and Trusts Introduction In the first part of this paper, NICE is discussed as one of the organizations that provide guidance on the provision of health services. The roles of the organization in the provision of public health guidance are discussed in most of part A of this paper. NICE is an organization that has a lot of information on the prevention of diseases. As such, it contains the various policies and procedures that are useful to healthcare practitioners, the population and different individuals in improving healthcare and the prevention of diseases in Wales and England. In this paper, the roles of NICE in the provision of guidance are outlined with a specific reference made to the guidance on domestic violence. Also, the other organizations that provide similar guidance are discussed in the essay. The political, social, environmental, and economic contexts of the guidance are also outlined in the paper. Further, the cost-effectiveness of the guidance is assessed and compared to the previous methods and the implications of the guidance are discussed. Part B of the paper focuses on a publicly funded healthcare system in a country. The National Health Service of the United Kingdom is selected for the study. The various ways in which the organization obtains funds and resources are discussed. In addition, the economic models are evaluated within the section and the various health funding by different governments are compared in part B of this paper. Five areas of public guidance NICE involves five different areas of public guidance. The first area is the guidance on the behaviour change. This guidance is mainly focussed on the individual approach. The aim of the guidance is to change the behaviours of persons at individual levels. It, therefore, recommends various behaviours that can result into healthy lifestyles amongst different group of people living in a region or area (NICE, 2014). Secondly, NICE offers guidance on exercise-referral-schemes. This guidance has more emphasis on physical exercises as stated on the definition. It aims to improve on the quality of physical exercises administered by medical practitioners or professionals. It helps the healthcare professionals to provide effective interventions in addition to the sensitization on the methods which can be used to promote physical activity. The methods are four in total. Also, Nice has been very active in the guidance on the various interventions to be used by schools to get rid of smoking. That demonstrates the roles of NICE in the fight against drug abuse. In that case, NICE makes use of schools and other learning institutions to reduce smoking amongst youngsters (NICE, 2010). The fourth guidance is on alcohol-use-conditions. The guidance is intended to identify and prevents the disorders that are associated with drinking of alcohol among adolescents and adults (NICE, 2010). Lastly, NICE gives guidance on the domestic abuse and violence in the society. The guidance is aimed at assisting the healthcare professionals to detect, prevent or reduce domestic abuse and violence. The role of nice in producing the guidance The area that talks on domestic violence will be discussed in this paper. It is because domestic violence has been one of the public health issues in the nation. As a result of that, the government considers it a criminal offence that is punishable by law (NHS, 2014). It has been a source of hospital admissions in the United Kingdom. Also, it has led to the death of the victims at times (who, 2013). For instance, two women die every week in the hands of their abusers, leading to a third of the female homicide cases in the country (Home Office, 2011). Domestic violence is referred to as any act of intimidating, controlling, violence, aggressive behaviour or abuse to individuals aged sixteen years or above that can result to physical, sexual, psychological, emotional or financial stress. There are various statistics that reveal the prevalence of the vice in the United Kingdom. For example, the statistics in England and Wales show that domestic violence victims aged between sixteen to fifty nine years are around 1.2 million. NICE is one of the independent establishments within the UK that provides national guidance which promotes good health and gives guidance to the professionals on the treatment and prevention of diseases. The organization was asked by the Health Department to provide guidance on ways of preventing, reducing or reduction of domestic abuse and violence (NICE, 2014). As a result of the task assigned to it by the Health department, NICE came up with an autonomous group referred to as the Programme-Development-Group. The group comprises of professionals from different disciplines. The disciplines include; social care, public health, clinicians, teachers, the representatives from various voluntary sectors, and the public (NICE, 2014).They deliberated the available data, recognized several gaps, and examined the observations that were made on the draft versions, before finally submitting their final recommendations to the NICE. The group examined the evidence available and considered the various comments made by different specialists and stakeholders from the research (NICE, 2014). That draft guidance, which comprised of the recommendations, was revised by the group (PDG), and handed over to the NICE for the necessary discussion in August in the year 2013 (NICE, 2014). NICE signed off the guidance and released it by its Guidance Committee the year 2014 within the month of February. The guidance is currently available on the NICE’S website. The recommendations were availed to the different professionals responsible for public health. In addition, the guidance was made available to the different members of the public interested in the guidance. Other organisations in producing the guidance One of the groups is the Programme-Development-Group. PDG is a group that comprises of several disciplines. They looked at the evidence available, identified the required modifications and made the necessary recommendations to the NICE for consideration (NICE, 2014). Secondly, there is the Social-Care-Institute-for-Excellence (SCIE).This group made a discussion of some of the crucial information they considered were never included in the guidance. The information was equally important and should have been considered for the inclusion in the guidance (NICE, 2014). The third group is the Centre-for-Public-Health-Excellence - (CPHE). This group was in charge of the robustness, credibility, and quality of the guidance. The organization was also responsible for the relevance of the guidance and to ensure that it was updated at all times (NICE, 2014). Fourth, there is the Public-Health-Advisory-Committee. The organization provided most of the recommendations used as the guidance. (NICE, 2014). In addition, there is the Citizens-Council- The group provided NICE with the general public outlook on the ethical and moral issues that had to be considered by the organization when carrying out its duties in guidance. The public health guidance process involved The public-health-guidance refers to the various policies that assist the healthcare practitioners, individuals, and populations to improve health and prevent diseases. There are various processes involved in this (NICE, 2014). The whole process began by the release of a draft copy or scope of the guidance. The release of the draft scope was followed by a series of meetings. The meetings were made to discuss the copy. During those meetings, various stakeholders gave their comments on the copy. The next step was the editing of the draft to factor in the comments from the various stakeholders. That was followed by the creation of Guidance Development Groups. After that, the accepted evidence reviews and economic modelling were then handed over to the PDG. What followed was the production of the recommendations of the draft. When the recommendations of the draft had been produced, the evidence and the draft guidance were confirmed for the field testing and discussion. The PDG then effected the revisions that were relevant to the various recommendations. Lastly, the final copy was posted on the website and the various comments that were to follow would be incorporated in the website. Socio-economic, political and environmental context Social context In the United Kingdom, more than ninety per cent of the domestic violence cases are committed by the male against their female counterparts. That type of abuse is often experienced and takes longer than that witnessed in other types of relationships (DH, 2005). According To the report made by the Home Office in the year 2014, almost thirty men and one hundred women are killed yearly by their ex-partners or partners. Domestic violence has adverse effects on employment of individuals. It is because the women or men who are affected are likely to take time off their workplaces or even quit their jobs completely. That result into many people in the society losing their jobs because of the crime committed against them by their partners or ex-partners (Oxford, 2005). Even though this type of violence has several negative effects on the individuals or victims, some of the instances or incidences of domestic violence are never reported by the victims. It is because of fear of violence or other forms or aggressions from the perpetrators.That makes the cases to be either underreported or unreported to the various law enforcing agencies and the healthcare professionals. The other reason for not reporting the cases is that the victims fear embarrassment and shame should their identities be revealed after going through the shameful act of domesticviolence. As a result, the statistics revealed by the NICE in the year 2014 reveal that the numbers have always been underestimated (Rose, 2011). Apart from the loss of employment, the women who are abused by their partners are likely to experience depression and suffer from human tract infections, vaginal bleeding, kidney infections, unexplained miscarriages, anxiety, hearing loss, sexual dysfunctions and kidney infections. The results of these effects are that the victims may be come suicidal and engage in substance or alcoholic abuse, self-harming, amongst other social activities. A large number of women that attend family planning, family care, and sexual and reproductive health settings are likely to have suffered from sexual abuse or domestic violence during their lifetime (Alhabib et al., 2010). Also, fifty-six per cent of the female psychiatric patients have reported having experienced domestic abuse or violence during their lifetime. That indicates the fact that the vice leads to mental and psychosocial problems in additional to the many problems and implications on the victims (Oram, 2013). Domestic violence has also resulted into homelessness amongst the victims. It is because the children and mothers who are affected always fear more of the violence. As a result, theyrun away from their homes toescape the violence as well as the shame and trauma they experience within the vicinity of the crime (Stanley, 2011). That indicates the contribution of domestic violence to homelessness amongst the victims. Political context The Government has constantly been changingthe various policies and legislations which are significant in the prevention of the domestic violence (NHS, 2014). That has been done to assist the victims of domestic violence have a new lease of life. The government has allocated more than forty million pounds to the healthcare professionals and the national-helplines to assist in prevention of the crime as well as the provision of specialised care to the victims (Home Office, 2010). There are other measures taken by the government to help prevent the crime. For instance, the Domestic-violence-disclosure-scheme in that gives various individuals the capability to confirm from the police department or other government agencies if his or her new partner has are a sexual abuser. They also get the past history of their partners in connection to sexual abuse cases (Home Office, 2010). The FGM act of 2003 and the abolition of stalking in the United Kingdom are some of the contributions of the government towards the prevention of the commission of the heinous act. Economic context The prevention and the treatment as well as care for the domestic violence victims are so costly that the government has to part with a lot of money in the exercise. For instance, the United Kingdom government had to use more than 15.7 billion pounds in the year 2008 in the process (Walby, 2009). That is quite a large sum of money that could be used in the treatment of chronic diseases, such as breast cancer or used in the other sectors of the economy in the United Kingdom. The government spends more than 4700 pounds per person in the treatment of the PTSD resulting from incidents of domestic violence. In addition, the support cost is estimated to be 4300 pounds per person for a three-month period (NICE, 2014). The cost for provision of cognitive-trauma-therapy was projected at 1600 pounds per individual. It included around nine sessions of the therapy offered by a professional psychologist (Smith, 2012).When all that money used in the various sessions is combined, it indicates the way in which the control and management of the domestic violence cases lead to the deprivation of the country’s economy and there should be various measures put in place to reduce the instances of domestic violence in the nation. The costs mentioned above are some of the expenses incurred by the government in the prevention and treatment of domestic violence. They indicate that domestic violence interferes with the country’s economy. It is because a lot of money is spent in the prevention and control of the vice. The money could be used in other sectors of the economy to spur economic growth. Environmental context Domestic violence does not impact only on the adults involved. It has more adverse effects on the children than that experienced by the parents. It is because the effects of living in homes where the vice is experienced may affect the development stages of the youngsters (Stanley, 2011). The experience of domestic violence may affect the emotional well-being and the behaviour of the children. That results into interference with other aspects of the child’s development like education. For instance, constant movement of the family as refugees may prevent the child from concentrating on one educational facility and lead to poor results or even lack of proper schooling (NSPCC, 2014). The children also exposed to such violence experience recurrent experiences of the same. As a result, they tend to practice it when they grow up (Walter & Smith, 2009). Guidance as cost effective The previous guidance issued by NICE in the year 2009 was aimed at identifying youngsters who were maltreated. This new guidance issued in the year 2014, however, will be more cost-effective. It will possess the advantage of equipping healthcare practitioners to be in a position to determine and provide necessary support to more people that suffer from the domestic violence (NICE, 2014). However, the new guidance will have to increase initial short-term costs. The costs include the resources to the government will use in the training of administrative staff and the health practitioners on when they should make referrals and how they will manage the confidential information they receive from the clients or other individuals (NICE, 2014). The relevant training offered by the new guidance leads to early identification as well as prevention. Medical practitioners without the relevant training on DV may give poor or inaccurate remedies that can cause complications. The complications are likely to lead to more costs (NICE, 2014). Evidence from the perspective of the United Kingdom indicates that those interventions were generally cost effective. The incremental cost-effective-ratio was 2450 pounds when an additional quality adjusted life year was valued at 20 000 pounds (NICE, 2014). The guidance can also lead to benefits and longer-term savings to both the social and health care. The criminal-justice-system and the NHS are also included. It is because the various individuals will be of good health and in a position to perform various tasks. Implications of Guidance for public health Many women and children utilize the healthcare system during their lifetime. As such, they interact with the healthcare practitioners or staff more than they come into contact with the police (NHS, 2014). Even though the healthcare system in London is one of the best in the world, the healthcare practitioners sometimes fail to diagnose the roots or causes of the deteriorating mental and physical health of the individuals (NHS, 2014). Some of the medical staff and professionals do not consider domestic violence as within their profession. Instead, they take it as a criminal justice case that should be handled by the police and the justice system. As a result, they fail to consider offering the necessary care required by the patients. That is due to their lack of proper training and time in handling the issue (NHS, 2014). The various recommendations to be used for the training as outlined in the guidance will be significant in assisting the establishment of a successful domestic violence care mechanism. That will increase the confidence of the healthcare practitioners and their expertise in dealing with the victims of DV (Taket, 2013). Finally, the guidance gives the guidelines on how to incorporate different family values in taking care of the victims of DV (nice, 2014). The responsibility of implementing the guidance lies with the local commissioners, healthcare professionals, and different providers. When performing this task, the different stakeholders should avoid being judgemental, but offer equal opportunity and embrace an open-minded relationship with the clients (NICE, 2014). References for part A National Institute for Health and Care Excellence, 2010. Alcohol-use disorders: preventing harmful drinking. http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf. (Accessed April 16 2014) National Institute for Health and Care Excellence, 2010. School-based interventions to prevent smoking. http://www.nice.org.uk/nicemedia/live/12827/47582/47582.pdf. (Accessed April 16 2014) National Society for the Prevention of Cruelty to Children, 2014. Children living with domestic abuse. http://www.nspcc.org.uk/help-and-advice/worried-about-a-child/online-advice/domestic-violence/domestic-violence_wda86312.html (Accessed April 20 2014) Oram, S., Trevillion, K., Feder, G., 2013. Prevalence of experiences of domestic violence among psychiatric patients: systematic review. The British Journal of Psychiatry (202): 94–9 Orford, J., 2005. Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. London: Taylor and Francis Rose, D., 2011. Barriers and facilitators of disclosures of domestic violence by mental health service users: qualitative study. British Journal of Psychiatric. 198 (3) 189-194. Stanley, N., 2011. Children experiencing domestic violence: a research review. Darlington, UK: Research in Practice. Smith, K., Osborne, S., Lau, I., 2012. Homicides, firearm offences and intimate violence: Supplementary volume 2 to Crime in England and Wales 2010/11. London Taket, A., Nurse, J., and Smith, K., 2003. Routinely asking women about domestic violence in health settings. British Medical Journal (327) 673-676.National Society for the Prevention of Cruelty Walby, S., 2009. The cost of domestic violence. http://www.lancs.ac.uk/fass/sociology/profiles/34/. (Accessed April 20 2014) Walby, S., and Allen, J., 2004. Home Office Research Study 276: Domestic violence, sexual assault and stalking: Findings from the British Crime Survey. http://www.lancs.ac.uk/fass/sociology/papers/walby-hors.pdf (Accessed April 30 2014) World Health Organisation, 2013. Violence against women. Intimate partner and sexual violence against women. WHO. Geneva. http://www.who.int/mediacentre/factsheets/fs239/en/(Accessed April 30 2014) ECONOMIC EVALUATION IN PUBLIC HEALTH MOD003654 Appendix for Part A Word page Depression7 Domestic Violence 22 DH 6 DV 11 Home Office 8 Homicide 3 National Health Service 2 NICE 2 NSPCC 9 PDG 3 PTSD 8 Public Health Advisory Committee 5 SCIE 5 The Citizens Council 3 PART B The National Health Service (NHS) Introduction I have chosen the National-Health-Service (NHS) In the United Kingdom for this essay. It is because it is amongst the world’s greatest publicly funded health facilities. In addition, it has been adjudged and considered the as one of the most democratic, efficient and comprehensive world’s healthcare system. It is free to all the citizens of the United Kingdom (NHS, 2013). The World-Health-Organisation describes the healthcare system as a combination of all the institutions and organisations in a nation whose main purpose is to increase the quality of healthcare or improve health. I will therefore focus on the NHS, which is the healthcare system available to the citizens and residents of the United Kingdom (WHO, 2014). The organisation is funded through a progressive-financial-system. That is done in the method of the direct taxation. The methodology used for the taxation enables redistribution all the citizens including the poor in the country through processes like cross-subsidisation (Qmul, 2012) hence in accordance to the rule of vertical equity (Mooney, 1992). Apart from certain charges imposed on dentistry, ophthalmology, and prescriptions, all the NHS treatments are always free for all the residents of the United Kingdom. However, individuals of low income, children, the elderly, the unemployed, and children are not charged by the NHS at all when they access the services (Coulter & Ham, 2000). The residents of the United Kingdom also have access to private healthcare-insurance. The insurance operates parallel to NHS. However, it contributes to a small percentage of the health expenses. The government estimates it to cover one tenth of the UK population (Smee, 2011). Background The wartime government came up with a report in the year 1992 that was entitled Social-Insurance-and-Allied-Services. The report was authored by one Sir Beveridge. He was a great economist. The aim of the report was to get rid of the 5 giants. The giants comprised of: squalor, want, idleness, ignorance, and disease (Beveridge, 1942). The report acted as the foundation of the NHS and the modern welfare state of the British government. As a result of the report, the NHS was formally launched on 5th July, 1948 by Bevin Aneurin, the then Health Minister (NHS, 2013). The NHS was founded on three principles: that it satisfies the needs of everyone; that it should be free at the delivery point, and that all the medical treatments are provided in accordance with the needs of the patients but not according to their ability to pay for the services (NHS, 2014). Despite the organisational and political challenges that have been experienced since the inception of the organisation, the three foundational principles still underpin the NHS (Bodenheimer, 2002). However, the several pressures that face the provision of health services in the country in addition to the scarcity of resources and other factors make it practically impossible to provide a completely free medical service (Mooney, 1992). As a result, the principle on the provision of free medical or healthcare is absent from the list of guiding principles of the NHS published in the year 2011 (DH, 2013). Seven Principles of the NHS 1. The NHS offers comprehensive healthcare service to all. 2. The access to the services offered by the NHS is based upon the various needs of the patients and not the pay 3. The NHS seeks to uphold the highest standards of professionalism and excellence 4. The NHS aspires to put patients at the heart of everything it does. 5. The NHS across the organisational boundaries and partners with the other organisations within the interests of the patients the extensive population and the local community. 6. The organisation is committed to the provision of the best value for the taxpayers money and the most fair, sustainable and effective utilisation of the finite resources. 7. The organisation has always been accountable for all the patients, individuals and the community that it serves Organisational Reform The publication of the White-Paper known as Equity-and-excellence: Liberating-the-NHS outlined the strategy by the government to come up with a patient-centred and responsive NHS that would achieve the best results in the universe (DH, 2010).The following Social-Care-Act of 2012 brought about the legislative mechanism that could be used in re-structuring the NHS. It involved changes to the main structure of the organisation (BMA, 1995). The changes impacted on many activities of the organisation including the commissioning of its services and its financial distribution. Most of the exercises began on first April, 2013 (Bentham, 1789). Finance The NHS obtains its funds through progressive taxation. This implies that the amount of tax imposed on the individuals for the purposes of healthcare is made based on the level of income. As such, the rich tend to pay more for the healthcare services. That does not mean that the poor citizens of the country do not receive medical care. The poor also receive medical care. It is just that the rich individuals subsidize the healthcare services offered to the poor and the other middle-class citizens (Chua, 2006). That is unlike the situation in the US. It is, however, similar to the type of healthcare provided in Canada. The progressive taxation makes the medical services affordable to all the citizens of the country. Some countries like the US only provide health insurance based on the premium payments. However, nations like Canada and the UK provide health services from the tax payers’ money through bodies like the NHS funded by the tax payers. That means that health services are free and available to all in Canada and the UK. It is unlike the US where only the working class have access to proper medical care (Chua, 2006). The spending on Health Care The WHO data of 2013 indicates that the United Kingdom spent 9.4 per cent of the country’s GDP on the provision of healthcare (WHO, 2013). That was comparatively less than that spent by a country like Canada that spent more than 10.9 per cent. Canada also uses a general healthcare system that is funded by the public taxes. In contrast, the US healthcare-system that comprises of a more active private sector and the public sector spent 17.9 per cent of its national GDP on health (USA, 2010). That shows a higher percentage as compared to the expenses made by the United Kingdom and Canada (Chua, 2006). Surprisingly, the more the countries spend on healthcare services, the lower the life expectancy in the nations. For instance, data obtained from the OECD indicate that in the nations which spend most on healthcare like Denmark and the United States, the life expectancy falls below the eighty years average (OECD, 2014). That discrepancy is attributed to some contributory and influential factors like the environment, and lifestyle. Many health professionals indicate that the health services can be measured (Loughlin, 1996). The factors that contribute to the low life expectancy can be least controlled by the medical practitioners. For instance, social conditions, the physical-environment and the lifestyle of the individuals cannot be controlled by the health professionals (Beauchamp, 2009). The NHS and Health Economics Demand and supply Originally, professionals in the healthcare sector believed that provision of the free healthcare could lead to more access to the services and improve on the overall health of the population in the nation (Hunter, 1998). That was, however, not the case. It’s because the various modifications and improvements that have been made in the sector, the increased expectation of the patients and longer life-expectancy have all increased the general demand for the medical services offered (Newdick, 2005). As a result, the demand has overwhelmed the supply of the medical or healthcare services. That has made the healthcare services to be inadequate to all the citizens of the nation.The fact the expenditure had not been properly planned contributes more to that. The DH asserts that the cost of medicine grows by over 600 million pounds yearly and that has been a common trend throughout the world (Dahlgreen & Whitehead, 1991). The pressures exerted on the NHS increases yearly due to the more sophisticated medical services that become available with time. In addition, the terminal and long-term conditions have become common as the population of the country grows old (Robbins, 1935). That has led to more pressure on the healthcare providers in the country (Hardin, 1968). This answers the question on the effect of more funding on the provision of healthcare services. It is quite perplexing that the more the various nations increase the funding on the provision of healthcare, the more the healthcare needs arise. Economists categorise the provision of healthcare as ‘merit-good’. It is because the consumption of the services leads to provision of benefits to the consumer as well as other individuals (Musgrave, 1989). Healthcare is considered as one of the inputs that are used in producing the output in the provision of health services. There are several other inputs. They include: exercise; nutrition, social factors, and lifestyle amongst others (Phillips, 2005). Unlike the common market principles, demand and supply in a healthcare setup are said to have various characteristics that have been analysed over time (Klarman, 1965). The healthcare system comprises of investment and consumption instead of the demand and supply, with the people directly involved in the consumption and production of the various services of health and healthcare (Loughlin, 1996). The other difference or contrast with the supply and demand theory is that the price in the NHS at the point-of-use is always zero (Williams, 1985). Also, the supply is less or more fixed at all times. In addition, the use of the imperfect agency in the provision of healthcare services makes it different from the common (Palmer & Ho, 2008). It is because it is difficult to know whether the doctor will act like a perfect agent in the patient-doctor relationship. Also, the demands for the healthcare services are based on the needs of the customers. The term need has very many definitions. As such, it cannot be compared with the normal wants of the customers in a normal demand supply relationship. One of the definitions is the normative need as described by the physicians (Steinbach, 2009). The normative need is described as different from the common demand. It is because it does not depend on the needs of the client or patient and their readiness to pay for the services (Levinsky, 1990). Instead, the healthcare services are needed, but never demanded like in the situation of immunisation and demanded but not needed by the patients as in the case of the cosmetic surgery. That shows the difference between the common demand and supply principle and the healthcare demand (Sullivan, 2003). The fact that the demand on the healthcare services depend on the assessment by the medical practitioners and not the patients indicates that there isuncertainty on when an individual can either be ill or to. The patients cannot determine their own healthcare needs unless it is determined by a doctor or a nurse. Since the increment in the needs of the patients affect the provision of services at the various healthcare centres, it demonstrates the consequences of uncertainties in the provision of healthcare. Scarcity of Resources The above description presents the NHS with a major problem of allocation of the finite resources to fulfil the needs and wants of the infinite demand. The issue is very significant in health-economics and the general economics of the nation (Williams, 1996). The problem is commonly referred to as the scarcity-of-resources. Within the health –economics, the problem is analogous to availability of insufficient resources that can satisfy the needs of the various individuals in need of healthcare (Phillips, 2005). Economics is considered a science that deals with the study of the behaviour of human beings like a relationship involving scarce means and ends that can be used in other areas (Robbins, 1932). According to the definition by Robbins, equilibrium cannot be met or reached as a result of the scarce resources. Allocation and distribution of the scarce resources in the NHS makes it necessary to give priority to the most relevant needs or wants of the patients and to ration the healthcare services provided (Hunter, 1998). According to the British-Medical-Association, the role of the priority setting within the NHS is to make a decision on the services that will be provided by the NHS. Rationing, on the other hand, comprises of making decisions on the individuals the treatment have to be denied or the services that should not be provided by the NHS. Resources have always been scarce. It will, therefore, not be possible to satisfy the all needs of everyone. As a result of rationing, there have been many controversies concerning various types of medications. For instance, the use of the drug called Sidenafil Citrate or the Viagra has led to a lot of controversy (Abbasi, 1999). Also, the ‘Child-B’ case, Jaymee Bowmen also made the work of NHS more difficult than before when defining priority (Hunter, 1998). Implicit and explicit Rationing The NHS uses both explicit and the implicit rationing. The explicit rationing is experienced when the organisation makes use of the focus groups, the QALY methodology and the health panels to assist in the process of decision making. In the case of implicit rationing, the firm uses lengthy form-filling, and waiting lists to make their decisions. There have been a lot of discussions on the use of the various rationing ways within the NHS (Doyal, 1997). The implicit rationing is more preferred than the explicit rationing. It is because in explicit rationing, people are likely to undergo deprivation disunity, especially when the individuals learn of the rationing of their cases (Coast, 1997). The people or economists that support explicit rationing assert that the benefit obtained from deception (deprivation disunity and avoiding denial-disutility) as in the case of implicit rationing can only be sustainable when the people or consumers are made ignorant of the rationing (Doyal, 1997). However, there has been an urge within the NHS to promote explicit rationing. As a result, NICE has managed to successfully introduce a successful, accountable, and systematic priority setting (Coast & Owen-Smith, 2011). Equity, Opportunity Cost, and Efficiency In healthcare systems like the NHS, all the funding choices are a representation of an opportunity cost; the resources used on one of the treatments cannot be utilized in another form of treatment. As a consequence, all the benefits that could have been derived from the medications are forgone (Drummond, 2005). Opportunity cost can, therefore, be described as the by-product of the resource scarcity that is an outcome of having to select one service or product over the other. Also, efficiency as a blend of effectiveness, economy, and equity, has to be considered when allocating resources. That is to ensure that the benefits the society receives are maximised (Knapp, 1984). The principle of pareto-efficiency is another concept that provides the criterion for the process of decision making when it comes to the distribution of scarce resources (Morris, 2007). Methods of Economic Analysis Economic analysis refers to the comparative examination of the alternate courses-of-action that relates to the outcomes and costs (McCabe, 2009). That is to ensure that efficiency is achieved when allocating the scarce resources. The different methods that are used in the allocation of scarce resources are discussed below (Morris, 2007). The first method is the cost-minimisation analysis. This analysis has its strengths when it comes to the straightforwardness in the comparison of costs. As such, it is useful in the comparison of the branded and the generic medicines. It is one of the methods used by the United Kingdom government policymakers in the health sector. The only disadvantage of this method is that it has limited-capacity for the wide, practical utilization. It is because it needs more evidence in order to prove that different interventions could have similar impacts on health. The second method is the Cost-effectiveness analysis. Its advantage is that it is useful when the when the proportions of the health impacts are not similar or identical but measured using the same units. Also, it can be utilised in addressing the efficiency issues. For example, it is used to show how to use the resources available to maximize the health output. However, it is not in a position to compare medicine with the other technologies in the health sector that call for the improvement of healthcare services in one or more dimensions. Thirdly, there is the Cost-utility analysis. This analysis is useful when health effects of different alternatives are in a position to be measured with reference to the overall effect on the quality and quantity of life. It is used to compare the interventions to be made for different forms of illnesses suffered by individuals. This is the analysis preferred by the NHS of the United Kingdom as compared to those of other nations like the United States and Canada. The only disadvantage of this analysis is that the QALYS may fail to capture the attached value to a healthcare intervention and it discriminates against certain sections of the society, such as the disabled and the old individuals. Lastly, there is the Cost-Benefit Analysis. This method permits the estimation of the net value of the treatment exercise. Since the benefits and costs are evaluated in a similar manner, the healthcare providers can easily determine the type of treatment that is worth providing (Nord, 1999). It is, therefore, preferred in the UK system where the provision of healthcare services is equal for all, unlike in the US. It is like the CUA. The only difference is that it measures its outcomes in monetary terms unlike the CUA which measures the same in terms of utility. However, the utilization of this method is restricted to the evaluation in situations that both the benefits and costs are valued in fiscal terms. In addition, it is difficult to provide the value of human life. It is because human life cannot be measured using the monetary terms (Mills & Gilson, 1988). Conclusion The NHS has both negative and positive aspects. The main advantage is the fact that it offers standard services thatare free to some extent (NHS, 2013). It has got no limit in the provision of healthcare services. However, the healthcare services offered by the NHS can be subject to consumers’ moral hazards. (Morris et al, 2007). In this situation, the patients may decide to consume more medical resources because of the fact that they have insurance cover. Scarcity of resources is also one of the largest disadvantages experienced by the NHS when offering its services. It is because it leads to rationing and the rationing may make some individuals not receive the necessary medical attention. Apart from the few disadvantages, the NHS has offered world class medical and healthcare services and is still committed to offering the same in the years to come (NHS, 2013). References for part B Abbasi, K., 1999. Viagra Rationed. BMJ 318 (7179) p.338. Available at: [Accessed 20th May 2014]. Beauchamp J,. 2009. Principles of Biomedical Ethics, 6th ed. Oxford: Oxford University Press. Bentham, J., 1789. The principles of Morals and Legislation. 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Health Systems: What is a Health System? [online]. Available at: [Accessed 5th May 2014]. Williams, A. H., 1985. Medical Ethics: Health Service Efficiency and Clinical Freedom. Nuffield/York Portfolio No. 2. London : Nuffield Provincial Hospitals Trust. Williams, A.H., 1996. QUALYS and Ethics: A Health Economist’s Perspective. Social Science & Medicine (43)12 pp.1795 – 1804. Appendix for Part B Word page Cross-Subsidisation Efficiency Equilibrium Equity GDP Immunisation OECD Opportunity cost Premium Payments QALY Scarcity Sidenafil Citrate Squalor 15 22 21 22 18 20 18 22 18 21 20 21 16 Read More