Skip to main content Accessibility help
×
    • You have access
    • Open access
  • Cited by 11
Publisher:
Cambridge University Press
Online publication date:
December 2023
Print publication year:
2024
Online ISBN:
9781009325974
Creative Commons:
Creative Common License - CC Creative Common License - BY Creative Common License - NC Creative Common License - ND
This content is Open Access and distributed under the terms of the Creative Commons Attribution licence CC-BY-NC-ND 4.0 https://creativecommons.org/creativelicenses
Series:
Elements of Improving Quality and Safety in Healthcare

Book description

This Element examines economic perspectives on improving quality and safety in healthcare. Though competition is generally recognised by economists as an important driver of improvement, it may not work so straightforwardly in healthcare – in part because some services are provided by very few organisations, but also because people are not always easily able to judge healthcare quality and rarely have to pay the full price for services. Different approaches for stimulating improvement are therefore needed, and the authors look at examples from the care home, primary care, and hospital sectors. They emphasise the need for economic evaluation of improvement efforts, based on the principle that improvement activities should only be undertaken if the benefits are worth at least the costs of implementing and running them. Using examples, they explain the economic approach to evaluating how benefits and costs of improvement efforts can be compared by applying cost-effectiveness analysis. This title is also available as Open Access on Cambridge Core.

References

1.Morris, S, Devlin, N, Parkin, D, Spencer, A. Economic Analysis in Healthcare. 2nd ed. John Wiley; 2012.
2.Newdick, C. Who Should We Treat? Rights, Rationing, and Resources in the NHS. 2nd ed. Oxford: Oxford University Press; 2005. https://doi.org/10.1093/acprof:oso/9780199264186.001.0001.
3.Mason, AR, Drummond, MF. Public funding of new cancer drugs: Is NICE getting nastier? Eur J Cancer 2009; 45: 1188–92. https://doi.org/10.1016/j.ejca.2008.11.040.
4.Henderson, J. The plastic surgery postcode lottery in England. Int J Surg 2009; 7: 550–8. https://doi.org/10.1016/j.ijsu.2009.09.004.
5.Shrank, WH, Rogstad, TL, Parekh, N. Waste in the US health care system: Estimated costs and potential for savings. JAMA 2019; 322: 1501–9. https://doi.org/10.1001/jama.2019.13978.
6.Simoens, S, De Coster, S. Potential savings from increased substitution of generic for originator medicines in Europe. J Generic Med 2006; 4: 43–5. https://doi.org/10.1057/palgrave.jgm.4950040.
7.Popp, W, Rasslan, O, Unahalekhaka, A, et al. What is the use? An international look at reuse of single-use medical devices. Int J Hyg Environ Health 2010; 213: 302–7. https://doi.org/10.1016/j.ijheh.2010.04.003.
8.Richardson, G. Identifying, evaluating and implementing cost-effective skill mix. J Nurs Manag 1999; 7: 265–70. https://doi.org/10.1046/j.1365-2834.1999.00137.x.
9.Drucker, PF. Innovation and Entrepreneurship. Oxford: Butterworth-Heinemann; 1985.
10.Care Quality Commission. How We Monitor, Inspect and Regulate Adult Social Care Services. www.cqc.org.uk/guidance-providers/adult-social-care/how-we-monitor-inspect-regulate-adult-social-care-services (accessed 1 March 2023).
11.NHS England. GP Contract Documentation 2020/21. www.england.nhs.uk/gp/investment/gp-contract/gp-contract-documentation-2020-21 (accessed 1 March 2023).
12.Roland, M. Linking physicians’ pay to the quality of care: A major experiment in the United Kingdom. N Engl J Med 2004; 351: 1448–54. https://doi.org/10.1056/NEJMhpr041294.
13.NHS England, NHS Improvement. National Tariff Payment System: 2022/23. www.england.nhs.uk/pay-syst/national-tariff/national-tariff-payment-system (accessed 1 March 2023).
14.Rodriguez Santana, I, Mason, A, Gutacker, N, et al. Need, demand, supply in health care: Working definitions, and their implications for defining access. Health Econ Policy Law 2023; 18: 113. https://doi.org/10.1017/s1744133121000293.
15.Mooney, G, Ryan, M. Agency in health care: Getting beyond first principles. J Health Econ 1993; 12: 125–35. https://doi.org/10.1016/0167-6296(93)90023-8.
16.Rice, T. The physician as the patient’s agent. In: Jones, A, ed. The Elgar Companion to Health Economics. 2nd ed. Cheltenham: Edward Elgar; 2013: 271–9.
17.James, G. Report of the Independent Inquiry into the Issues raised by Paterson. London: HMSO; 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/863211/issues-raised-by-paterson-independent-inquiry-report-web-accessible.pdf (accessed 19 May 2020).
18.Globerman, S. Select Cost Sharing in Universal Health Care Countries. Vancouver, Canada: Fraser Institute; 2016. www.fraserinstitute.org/studies/select-cost-sharing-in-universal-health-care-countries (accessed 1 March 2023).
19.Competition & Markets Authority. Care Homes Market Study: Update Paper. London: CMA; 2017. https://assets.publishing.service.gov.uk/media/5941057be5274a5e4e00023b/care-homes-market-study-update-paper.pdf (accessed 19 May 2020).
20.LaingBuisson. Care Homes for Older People UK Market Report. 32nd ed. London: LaingBuisson; 2022. www.laingbuisson.com/shop/care-homes-for-older-people-uk-market-report-32ed (accessed 1 March 2023).
22.Forder, J, Allan, S. The impact of competition on quality and prices in the English care homes market. J Health Econ 2014; 34: 7383. https://doi.org/10.1016/j.jhealeco.2013.11.010.
23.Allan, S, Forder, J. The determinants of care home closure. Health Econ 2015; 24: 132–45. https://doi.org/10.1002/hec.3149.
24.Matthews-King, A. ‘Alarming rise’ in reports of care home abuse in England. The Independent (London); 23 June 2019. www.independent.co.uk/news/health/abuse-care-home-cqc-autism-learning-disability-whorlton-hall-police-a8969026.html (accessed 1 March 2023).
25.NHS Digital. Patients Registered at a GP Practice January 2020; Special Topic. https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice/january-2020 (accessed 19 May 2020).
26.Santos, R, Gravelle, H, Propper, C. Does quality affect patients’ choice of doctor? Evidence from England. Econ J 2017; 127: 445–94. https://doi.org/10.1111/ecoj.12282.
27.Gravelle, H, Liu, D, Propper, C, Santos, R. Spatial competition and quality: Evidence from the English family doctor market. J Health Econ 2019; 68: 102249. https://doi.org/10.1016/j.jhealeco.2019.102249.
28.Nagraj, S, Abel, G, Paddison, C, et al. Changing practice as a quality indicator for primary care: Analysis of data on voluntary disenrollment from the English GP Patient Survey. BMC Fam Pract 2013; 14: 89. https://doi.org/10.1186/1471-2296-14-89.
29.Stokes, T, Dixon-Woods, M, McKinley, RK. Ending the doctor–patient relationship in general practice: A proposed model. Fam Pract 2004; 21: 507–14. https://doi.org/10.1093/fampra/cmh506.
30.Maynard, A, Marinker, M, Pereira-Gray, D. The doctor, the patient, and their contract. III. Alternative contracts: Are they viable? BMJ 1986; 292: 1438–40. https://doi.org/10.1136/bmj.292.6533.1438.
31.Department of Health. Working for Patients. CM 555. London: HMSO; 1989.
32.Dusheiko, M, Gravelle, H, Jacobs, R, Smith, P. The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment. J Health Econ 2006; 25: 449–78. https://doi.org/10.1016/j.jhealeco.2005.08.001.
33.Moberly, T, Stahl-Timmins, W. QOF now accounts for less than 10% of GP practice income. BMJ 2019; 365: l1489. https://doi.org/10.1136/bmj.l1489.
34.Doran, T, Kontopantelis, E, Valderas, JM, et al. Effect of financial incentives on incentivised and non-incentivised clinical activities: Longitudinal analysis of data from the UK Quality and Outcomes Framework. BMJ 2011; 342: d3590. https://doi.org/10.1136/bmj.d3590.
35.Doran, T, Fullwood, C, Kontopantelis, E, Reeves, D. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: Analysis of clinical activity indicators for the quality and outcomes framework. Lancet 2008; 372: 728–36. https://doi.org/10.1016/S0140-6736(08)61123-X.
36.Forbes, L, Marchand, C, Peckham, S. Review of the Quality and Outcomes Framework in England: Final Report. University of Kent: PRUComm; 2016. https://prucomm.ac.uk/assets/uploads/blog/2017/02/Review-of-QOF-21st-December-2016.pdf (accessed 6 May 2021).
37.Ryan, AM, Krinsky, S, Kontopantelis, E, Doran, T. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: A population study. Lancet 2016; 388: 268–74. https://doi.org/10.1016/S0140-6736(16)00276-2.
38.Checkland, K, McDonald, R, Harrison, S. Ticking boxes and changing the social world: Data collection and the new UK general practice contract. Soc Policy Admin 2007; 41: 693710. https://doi.org/10.1111/j.1467-9515.2007.00580.x.
39.Webster, C. The National Health Service: A Political History. Oxford: Oxford University Press; 1998.
40.Busse, R, Geissler, A, Aaviksoo, A, et al. Diagnosis related groups in Europe: Moving towards transparency, efficiency, and quality in hospitals? BMJ 2013; 346: f3197. https://doi.org/10.1136/bmj.f3197.
41.Grašič, K, Mason, A, Street, A. Paying for the quantity and quality of hospital care: The foundations and evolution of payment policy in England. Health Econ Rev 2015; 5: 15. https://doi.org/10.1186/s13561-015-0050-x.
42.O’Reilly, J, Busse, R, Häkkinen, U, et al. Paying for hospital care: The experience with implementing activity-based funding in five European countries. Health Econ Policy Law 2012; 7: 73101. https://doi.org/10.1017/S1744133111000314.
43.NHS England. Consultant Outcomes Publication. www.england.nhs.uk/2014/11/outcome-publication (accessed 19 May 2020).
44.Healthcare Quality Improvement Partnership. Clinical Outcomes Publication. www.hqip.org.uk/national-programmes/clinical-outcomes-publication/#.Xj2SLmj7TIU (accessed 19 May 2020).
45.Bevan, G, Hood, C. What’s measured is what matters: Targets and gaming in the English public health care system. Public Admin 2006; 84: 517–38. https://doi.org/10.1111/j.1467-9299.2006.00600.x.
46.NHS England, NHS Improvement. National Tariff Payment System 2022/23. Annex C: Guidance on Best Practice Tariffs. London: NHS England and NHS Improvement; 2022. www.england.nhs.uk/wp-content/uploads/2020/11/22-23NT_Annex-C-Best-practice-tariffs.pdf (accessed 1 March 2023).
47.McIlvennan, CK, Eapen, ZJ, Allen, LA. Hospital readmissions reduction program. Circulation 2015; 131: 1796–803. https://doi.org/10.1161/CIRCULATIONAHA.114.010270.
48.Milstein, R, Schreyoegg, J. Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries. Health Policy 2016; 120: 1125–40. https://doi.org/10.1016/j.healthpol.2016.08.009.
49.Drummond, M, McGuire, A. Economic Evaluation in Health Care: Merging Theory with Practice. Oxford: Oxford University Press; 2001.
50.Drummond, M, Sculpher, M, Claxton, K, Stoddart, G, Torrance, G. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.
51.Shah, K, Praet, C, Devlin, N, et al. Is the aim of the English health care system to maximize QALYs? J Health Serv Res Policy 2012; 17: 157–63. https://doi.org/10.1258/jhsrp.2012.011098.
52.Williams, A. The economic role of health indicators. In: Smith, GT, ed. Measuring the Social Benefit of Medicine. London: Office of Health Economics; 1983: 63–7.
53.Lovibond, K, Jowett, S, Barton, P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modelling study. Lancet 2011; 378: 1219–30. https://doi.org/10.1016/S0140-6736(11)61184-7.
54.Roze, S, Isitt, J, Smith-Palmer, J, Javanbakht, M, Lynch, P. Long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring versus self-monitoring of blood glucose in patients with type 1 diabetes in the U.K. Diabetes Care 2020; 43: 2411–7. https://doi.org/10.2337/dc19-2213.
55.Stahl, JE, Sandberg, WS, Daily, B, et al. Reorganizing patient care and workflow in the operating room: A cost-effectiveness study. Surgery 2006; 139: 717–28. https://doi.org/10.1016/j.surg.2005.12.006.
56.Wu, RC, Laporte, A, Ungar, WJ. Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. J Eval Clin Pract 2007; 13: 440–8. https://doi.org/10.1111/j.1365-2753.2006.00738.x.
57.Morris, S, Ramsay, AIG, Boaden, RJ, et al. Impact and sustainability of centralising acute stroke services in English metropolitan areas: Retrospective analysis of hospital episode statistics and stroke national audit data. BMJ 2019; 364: l1. https://doi.org/10.1136/bmj.l1.
58.Basu, A. Estimating costs and valuations of non-health benefits in cost-effectiveness analysis. In: Neumann, PJ, Sanders, GD, Russell, LB, Siegel, JE, Ganiats, TG, eds. Cost-effectiveness in Health and Medicine. 2nd ed. Oxford: Oxford University Press; 2017: 201–36.
59.Basu, A, Meltzer, D. Implications of spillover effects within the family for medical cost-effectiveness analysis. J Health Econ 2005; 24: 751–73. https://doi.org/10.1016/j.jhealeco.2004.12.002.
60.Tubeuf, S, Saloniki, E-C, Cottrell, D. Parental health spillover in cost-effectiveness analysis: Evidence from self-harming adolescents in England. PharmacoEcon 2019; 37: 513–30. https://doi.org/10.1007/s40273-018-0722-6.
62.Williams, A. Economics of coronary artery bypass grafting. BMJ 1985; 291: 326–9. https://doi.org/10.1136/bmj.291.6491.326.
62.MacKillop, E, Sheard, S. Quantifying life: Understanding the history of quality-adjusted life-years (QALYs). Soc Sci Med 2018; 211: 359–66. https://doi.org/10.1016/j.socscimed.2018.07.004.
63.Prieto, L, Sacristán, JA. Problems and solutions in calculating quality-adjusted life years (QALYs). Health Qual Life Outcomes 2003; 1: 80. https://doi.org/10.1186/1477-7525-1-80.
64.Richardson, J, Iezzi, A, Khan, MA. Why do multi-attribute utility instruments produce different utilities: The relative importance of the descriptive systems, scale and ‘micro-utility’ effects. Qual Life Res 2015; 24: 2045–53. https://doi.org/10.1007/s11136-015-0926-6.
65.Spiegelhalter, D, Gore, S, Fitzpatrick, R, et al. Quality of life measures in health care. III: Resource allocation. BMJ 1992; 305: 1205–9. https://doi.org/10.1136/bmj.305.6863.1205.
66.Toulany, A, Shojania, K. Measurement for improvement. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., eds. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; forthcoming.
67.Briggs, A, Sculpher, M, Claxton, K. Decision Modelling for Health Economic Evaluation. Oxford: Oxford University Press; 2006.
68.Gray, AM, Clarke, PM, Wolstenholme, J, Wordsworth, S. Applied Methods of Cost-Effectiveness Analysis in Healthcare. Oxford: Oxford University Press; 2010.
69.Gaughan, J, Liu, D, Gutacker, N, et al. Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals? A retrospective observational study. BMJ Open 2022; 12: e055976. https://doi.org/10.1136/bmjopen-2021-055976.
70.Maynard, A. The powers and pitfalls of payment for performance. Health Econ 2011; 21: 312. https://doi.org/10.1002/hec.1810.
71.Claxton, K, Martin, S, Soares, M, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess 2015; 19(14). https://doi.org/10.3310/hta19140.
72.Guthrie, B, Payne, K, Alderson, P, McMurdo, MET, Mercer, SW. Adapting clinical guidelines to take account of multimorbidity. BMJ 2012; 345: e6341. https://doi.org/10.1136/bmj.e6341.
73.Salisbury, C, Man, M-S, Chaplin, K, et al. A patient-centred intervention to improve the management of multimorbidity in general practice: The 3D RCT. Health Serv Deliv Res 2019; 7(5). https://doi.org/10.3310/hsdr07050.
74.Thorn, J, Man, M-S, Chaplin, K, et al. Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: A pragmatic cluster randomised controlled trial. BMJ Open 2020; 10: e030110. https://doi.org/10.1136/bmjopen-2019-030110.
75.Pandya, A, Doran, T, Zhu, J, et al. Modelling the cost-effectiveness of pay-for-performance in primary care in the UK. BMC Med 2018; 16: 135. https://doi.org/10.1186/s12916-018-1126-3.
76.Walker, S, Mason, AR, Claxton, K, et al. Value for money and the Quality and Outcomes Framework in primary care in the UK NHS. Br J Gen Pract 2010; 60: e213–20. https://doi.org/10.3399/bjgp10X501859.
77.Meacock, R, Doran, T, Sutton, M. What are the costs and benefits of providing comprehensive seven-day services for emergency hospital admissions? Health Econ 2015; 24: 907–12. https://doi.org/10.1002/hec.3207.
78.Le Grand, J. The theory of government failure. Br J Polit Sci 1991; 21: 423–42. https://doi.org/10.1017/S0007123400006244.
79.Wolf, C. Markets or Governments: Choosing between Imperfect Alternatives. 2nd ed. Cambridge, MA: MIT Press; 1993.
80.Klein, N. The Shock Doctrine. London: Penguin; 2008.
81.Arrow, KJ. Uncertainty and the welfare economics of medical care. Am Econ Rev 1963; 53: 941–73. www.jstor.org/stable/1812044 (accessed 1 March 2023).
82.Fuchs, V. Kenneth Arrow’s legacy and the article that launched a thousand studies. Health Affairs; 8 March 2017. https://doi.org/10.1377/forefront.20170308.059100.
83.Hansen, P. Health sector decision-making: More than just cost per QALY calculations. J Health Serv Res Policy 2012; 17: 129–30. https://doi.org/10.1258/JHSRP.2012.012058.
84.Ryan, M, Gerard, K. Inclusiveness in the health economic evaluation space. Soc Sci Med 2014; 108: 248–51. https://doi.org/10.1016/j.socscimed.2014.01.035.
85.Martin, G, Dixon-Woods, M. Collaboration-based approaches. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., eds. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; 2022. https://doi.org/10.1017/9781009236867.
86.Morris, S, Hunter, RM, Ramsay, AIG, et al. Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: Difference-in-differences analysis. BMJ 2014; 349: g4757. https://doi.org/10.1136/bmj.g4757.
87.Bojke, C, Grašič, K, Street, A. How should hospital reimbursement be refined to support concentration of complex care services? Health Econ 2018; 27: e2638. https://doi.org/10.1002/hec.3525.
88.Walker, S, Griffin, S, Asaria, M, Tsuchiya, A, Sculpher, M. Striving for a societal perspective: A framework for economic evaluations when costs and effects fall on multiple sectors and decision makers. Appl Health Econ Health Policy 2019; 17: 577–90. https://doi.org/10.1007/s40258-019-00481-8.
89.Ramponi, F, Walker, S, Griffin, S, et al. Cost-effectiveness analysis of public health interventions with impacts on health and criminal justice: An applied cross-sectoral analysis of an alcohol misuse intervention. Health Econ 2021; 30: 972–88. https://doi.org/10.1002/hec.4229.
90.Hinde, S, Walker, SM, Lortie-Forgues, H. Applying the Three Core Concepts of Economic Evaluation in Health to Education in the UK. Discussion Paper. CHE Research Paper. York: Centre for Health Economics, University of York; 2019. https://eprints.whiterose.ac.uk/153488 (accessed 1 March 2023).
91.Fuchs, VR. Who Shall Live? Health, Economics and Social Choice. 2nd ed. Singapore: World Scientific; 2011. https://doi.org/10.1142/8167.
92.Cookson, R, Goddard, M, Sheldon, T, eds. Maynard Matters: Critical Thinking on Health Policy. York: YPS; 2016.
93.Briggs, A, Sculpher, M, Claxton, K. Decision Modelling for Health Economic Evaluation. Oxford: Oxford University Press; 2006.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Book summary page views

Total views: 0 *
Loading metrics...

* Views captured on Cambridge Core between #date#. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.