Friday, 4 April 2014

Waste due to clinical management according to Berwick and Halvorson

Donald Berwick’s reviews have a great impact in the US, as well as being for a short period of time the CMS Administrator, surely the public health agency that moves the biggest budget in the world, was very well known in his time as the President of the Institute for Healthcare Improvement. Berwick and his colleague Hackbarth in this JAMA article, put a value on the waste of resources in the US. They say the cross cuts do not promote structural change and that in exchange, they can damage services of proven quality. For this reason, the study's authors strive to show where the waste is, i.e. where there are performances that if left out, the quality would remain unaffected or may even improve.

The authors believe that the overall savings of the system could be in a range going from 21% to 47%, but if you read the article carefully and ignore the parts about the complexities specific to the American system, it turns out that the estimate obtained out of the waste due to clinical errors, poor coordination between levels of care and overtreatment, would be as indicated in the chart above, at an average value of 13% and a range that would go from 12 to 16%.

George Halvorson, chairman of Kaiser Permanente, published in 2009 the book that can be seen in the above chart, which states that we should not expect the health system to reform itself. In this work, Halvorson cites a project that focused on common chronic diseases and was conducted by The Commonwealth Fund with more than 5 million records. However, the study concludes that the potentially preventable complications could reach 25% of the health budget. For this reason, the author of the book concludes that out of the $ 3 trillion of the overall budget of American health care, at least half a trillion would be wasted in clinical actions that do not add any value to the health of people. Despite that, given the difficulties in collecting these supposed savings, the author admits that even if only half of this figure would be collected it would be sufficient to finance the reform promoted by President Obama.

We seem to know, more or less, the barn’s capacities and types of grain that’s in store, but the question then is: how can we recover the resources stored in  these huge barns in order to finance the  actions and programs that are supposedly more beneficial to the health of people?

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

Jordi Varela


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