English National Health Service's savings plan may have helped reduce the use of three 'low-value' procedures.
The pressure to contain health expenditures is unprecedented. In England a flattening of the health budget but increasing demand led the National Health Service (NHS) to seek reductions in health expenditures of 17 percent over four years. The spending cuts were to be achieved through improvements in service quality and efficiency, including reducing the use of ineffective, overused, or inappropriate procedures. However, the NHS left it to the local commissioning (or funding) organizations, known as primary care trusts, to determine what steps to take to reduce spending. To assess whether the initiative had an impact, we examined six low-value procedures: spinal surgery for lower back pain, myringotomy to relieve eardrum pressure, inguinal hernia repair, cataract removal, primary hip replacement, and hysterectomy for heavy menstrual bleeding. We found significant reductions in three of the six procedures-cataract removal, hysterectomy, and myringotomy-in the program's first year, compared to prior years' trends. However, changes in the rates of all examined procedures varied widely across commissioning organizations. Our findings highlight some of the challenges of making major budget cuts in health care. Reducing ineffective spending remains a significant opportunity for the US health care system, and the English experience may hold valuable lessons.
Sophie Coronini-Cronberg (s.coronini-cronberg@imperial.ac.uk) is an honorary research fellow in the Department of Primary Care and Public Health, Imperial College London, and a consultant in public health in the Centre Medical Directorate with Bupa, both in the United Kingdom.
Sophie
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Coronini-Cronberg
Honor Bixby is a PhD candidate in the Department of Epidemiology and Biostatistics, Imperial College London.
Honor
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Bixby
Anthony A. Laverty is a research fellow in the Department of Primary Care and Public Health, Imperial College London.
Anthony A
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Laverty
Robert M. Wachter is a professor and associate chair of the Department of Medicine, University of California, San Francisco, where he holds the Benioff Endowed Chair in Hospital Medicine.
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Wachter
Christopher Millett is a National Institute for Health Research professor of public health in the Department of Primary Care and Public Health, Imperial College London.
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Millett
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000379:methods*; D017558:Elective Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D018855:Single-Payer System / Q000191:economics / Q000458:organization & administration; D013222:State Medicine / Q000191:economics* / Q000458:organization & administration; D006113:United Kingdom; D055815:Young Adult
Cost of Health Care; Financing Health Care; Health Reform; Health Spending; Politics