This document discusses reducing waste and improving efficiencies in healthcare systems to improve quality. It notes that annual growth in healthcare expenditures is a problem in OECD countries. The primary goal of healthcare policy should be to maximize population health within available resources and with principles of equity and solidarity. Improving value for money in healthcare can be achieved through more cost-effective interventions that provide greater health effects for lower costs. Benchmarking cost-effectiveness against thresholds like GDP per capita can help identify good value interventions. Examples show potential cost savings from reducing overuse and investing more in prevention and innovation to reinvest in health. A crucial condition for success is developing a perfect eHealth system.

1. Reducing waste and efficiencies
in healthcare  improving
quality
Lieven Annemans

2. Consequences of the crisis…
2
AnnualgrowthofhealthcareexpendituresintheOECD
(OECD health statistics 2015)

3. “Health is a value in itself.
It is also a precondition for
economic prosperity. People’s
health influences economic
outcomes in terms of
productivity, labour supply,
human capital and public
spending.”

4. The real goal of health care
systems
Primary goal of health care policy = to produce health
= to maximize the health of the population within the
limits of the available resources, and within an ethical
framework built on equity and solidarity principles.
4
Report of the Belgian EU Presidency, adopted by the EU
Council of Ministers of Health in Dec 2010

5. 5
Value for money
Cost
Health effect
(e.g. QALYs)
Current
care
Treatmentcost
Savings
SavingsNetCExtraC
HighnetCostL. Annemans. Health economics for non-economists.
Academiapress, 2008

6. 6
Cost
Health effect
(QALYs)
Current
care
NOT C-Eff
C-Eff
Dominant
Threshold (1 to 3x GDP/capita)
New
New
Cost-effectiveness
New

7. 7
PROBLEM: where is the threshold?
• BENCHMARKING
• e.g. cost-effectiveness of caring for a dialysis patient
historically 50,000 $ per QALY:
• WHO: Highly cost-effective (< GDP per capita); Cost-
effective (between one and three times GDP per capita);
(e.g. Belgium = +/- €35000)
http://www.who.int/choice/costs/CER_thresholds/en/
• At the discretion of the decision maker… (England
25,000£/QALY

8. Examples: “league table”
8
Intervention Net cost QALY gain ICER
Training for caregivers of stroke patients -6,000 0.00 Dominant
Diabetes education and self management for patients
newly diagnosed with type 2 diabetes
200 0.04 5,000
Daily dialysis compared to dialysis every other day for
60 year-old men with kidney injury
13,000 2.14 6,000
ICD (implantable cardioverter defibrillator) for
patients who are at risk for sudden death due to left
ventricular systolic dysfunction
113,000 3.00 38,000
Annual CT for 60 year-old heavy smokers 6,000 0.04 140,000
Screen & treat osteoporosis for men age 65 and older
with no prior fracture
4,000 0.03 150,000
https://research.tufts-nemc.org/cear4/Resources/LeagueTable.aspx
ICER = Incremental Cost Effectiveness Ratio

9. 9
Bekelman et al, JAMA, January 2016
27.7
24.8
21.7
19.0
18.3
17.8
10.7
10.6
6.0
5.0
5.0
7.4
7.0
5.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Belgium
Norway
Germany
Canada
England
Netherlands
USA
Hospital days end of life
last 30d last 180d

10. =

11. Overuse
More
Prevention
&
Innovation
Re-investing in health !

12. 12
George Halvorson,
CEO,Kaiser Permanente
interview http://vimeo.com/4039344
A crucial condition  a perfect
eHealth system

13. Reducing waste and efficiencies
in healthcare  improving
quality
Lieven Annemans