Monday, 7 April 2014

Four ways to make Sutton’s law a reality

It occurs to me that there are four possible approaches to address Sutton's law (remember that this law tells us that we have to go after the waste to raise funds for activities that really provide a health value to people, see post March 28th) and I think we need the four approaches at once:

1. Medical service based on patient preference (see post February 27th)

There is a report from a Cochrane review that says that when patients have contrasting information, other than from their doctor, they have a tendency to choose more conservative therapies within the range that is offered with their diagnosis. And, according to some researchers, up to a 20% reduction in some scheduled surgical procedures can be expected with this method.

2. The role of scientific associations in addressing evidence-based medicine

The difficulties in the practice of medicine begin in the gap that exists between the scientific evidence and the reality of clinical practice. In this area there is a missing link that causes a striking variability in clinical practice and the utilization of health care resources. For this reason, in recent times interesting professional initiatives are being observed (which we will discuss further in later posts), of which highlight "Do not do" from NICE in the UK and "Choosing Wisely” from ABIM Foundation in USA.

3. The organizational rearrangements focused on the patients’ needs

The experiences that have broken the mould in hospitals and primary care or between health and social services, are leading the way forward, although none of these experiences by themselves have succeeded well enough to replicate and spread systematically. As an example I would cite the case of care (and prevention) of diabetes mellitus type II in the Spanish primary care system, a globally unique case (see post March 3th) and the integration of health and social care in Torbay England of programs aiming to care for frail elderly people with complex needs (see post March 24th).

4. The analytical method: the benchmarking (see post March 31th)

Benchmarking has the strength of providing comparative statistics but weakness as a method in delivering change to the core business. It is therefore a very useful method when the deviations are very obvious, but it appears that the professionals are reluctant to admit it. The "Milliman Research Report" states that, if only the most wasteful U.S. hospitals would adopt the clinical practices of the least wasteful U.S. hospitals, a reduction in expenditure between 12% and 16% could be expected.


Berwick D. What “Patient Centered” Should Mean: Confessions of an Extremist. Health Affairs 2009, 28(4):555-65.

Pyenson et al. Imaging 16% to 12%, A Vision for Cost Efficiency, Improving Healthcare Quality, and Covering the Uninsured. Milliman Research Report. February 2009.

Jordi Varela


No comments:

Post a Comment