Health services accreditation: what is the evidence that the benefits justify the costs?
OBJECTIVE
To identify and analyse research on the use of economic evaluation in health services accreditation.


METHODS
Seven online health and economic databases, and key accreditation agency and health department websites were searched between June and December 2011.


METHODS
The selection criteria were English language and published empirical research studies on the topic of economic evaluation of health service accreditation. No formal economic evaluation of health services accreditation has been carried out to date. Empirical data on costs and benefits were analysed in 6 and 15 studies, respectively. Data extraction Meta-analysis was unsuitable due to output variability. Attributes relating to


METHODS
scalability and independence of outcome data were collected. For the benefit studies, we also assessed the strength of claim that accreditation improved patient safety and quality, and sources of potential bias.


RESULTS
The incremental costs ranged from 0.2 to 1.7% of total costs averaged over the accreditation cycle. The benefit studies were inconclusive in terms of showing clear evidence that accreditation improves patient safety and quality of care.


CONCLUSIONS
The lack of formal economic appraisal makes it difficult to evaluate accreditation in comparison to other methods to improve patient safety and quality of care. The lack of a clear relationship between accreditation and the outcomes measured in the benefit studies makes it difficult to design and conduct such appraisals without a more robust and explicit understanding of the costs and benefits involved.
Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia. v.mumford@unsw.edu.au.
Virginia
V
Mumford
Kevin
K
Forde
David
D
Greenfield
Reece
R
Hinchcliff
Jeffrey
J
Braithwaite
D000068:Accreditation / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000191:economics; D006296:Health Services / Q000191:economics / Q000592:standards*; D006801:Humans; D011787:Quality of Health Care / Q000191:economics / Q000592:standards
certification/accreditation of hospitals; economic evaluation (cost effectiveness); external quality assessment; general methodology; patient safety; quality management; quality measurement