i) services and processes that are either harmful or do not deliver benefits; and
ii) costs that could be avoided by substituting cheaper alternatives with identical or better benefits. Linking actors – patients, clinicians, managers and regulators – to key drivers of waste – errors and suboptimal decisions, poor organisation and co-ordination, incentives misaligned with health care system goals, and intentional deception – helps to identify three main categories of wasteful spending:
- Wasteful clinical care covers avoidable instances when patients do not receive the right care. This includes duplicate services, preventable clinical adverse events – for instance, wrong-site surgery and many infections acquired during treatment – and low-value care – for instance, medically unnecessary caesarean sections or imaging.
- Operational waste occurs when care could be provided using fewer resources within the system while maintaining the benefits. Examples include situations where pharmaceuticals or medical devices are discarded unused or where lower prices could be obtained for the inputs purchased (for instance, by using generic drugs instead of originators). In other instances, costly inputs are used instead of less expensive ones, with no additional benefit to the patient. In practical terms, this is often the case when patients seek care in emergency departments, end up in the hospital due to preventable exacerbation of chronic disease symptoms that could have been treated at the primary care level, or cannot be released from a hospital in the absence of adequate follow-on care.
- Governance-related waste pertains to resources that do not directly contribute to patient care. This category comprises unneeded administrative procedures, as well as fraud, abuse and corruption, all of which divert resources from the pursuit of health care systems’ goals.
Source: Organisation for Economic Cooperation and Development (2017) Tackling Wasteful Spending on Health. OECD Publishing, Paris. pp. 11-12. http://dx.doi.org/10.1787/9789264266414-en
Improving the outcomes that matter to an individual for a given amount of resources (money, leadership, time, assets, and carbon) used not only by the health system but also by the individual and their family, recognising that the experience of care is a critical element.
Source: Oxford Centre for Triple Value Healthcare
Three examples of the term in use:
One doctors’ waste is another patient’s delay. Potentially, it could be that other patient’s lack of treatment.
Maughan D, Ansell J (2014) Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. Academy of Medical Royal Colleges. November 2014. Page 3. https://www.aomrc.org.uk/wp-content/uploads/2016/05/Protecting_Resources_Promoting_Value_1114.pdf
Corporate management has been largely responsible for waste reduction in health care for too long. In primary care, wards, clinics and theatres, there are many types of waste that cannot be tackled without medical expertise. Investigations, medications, hospital beds and theatre time, are all resources that doctors use on a daily basis.
Deciding how and when to use these resources are clinical questions that can only be answered by those with sufficient training and experience. Waste arises from using these clinical resources inefficiently or unnecessarily. Inappropriate use of clinical resources is waste and this waste relates directly to clinical practice and needs to be tackled by those best equipped to do so: doctors.
Maughan D, Ansell J (2014) Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. Academy of Medical Royal Colleges. November 2014. Page 8. https://www.aomrc.org.uk/wp-content/uploads/2016/05/Protecting_Resources_Promoting_Value_1114.pdf
Pharmaceuticals constitute a major source of operational wastefulness. In OECD countries, pharmaceutical spending comprises between 6.7 and 30.2% of national healthcare budgets. Two irrefutable ways to tackle waste in pharmaceutical spending is through bulk purchasing and replacing originator with cheaper generic drugs.
Colombo F (2018) Healthcare systems: Tackling waste to boost resources. Last update: 4 January 2018. OECD Observer. https://www.oecd-ilibrary.org/sites/f5719ebb-en/index.html?itemId=/content/paper/f5719ebb-en