Session 4.2 – Identifying Priorities for Disinvestment and Reallocation
Thursday October 30 11:30-12:30
Defining ‘Disinvestment’ in a Health Service Context
(Abstract 0091)Claire Harris, Greg Rumbold, Kelly Allen, Tari Turner
Centre for Clinical Effectiveness, Southern Health, Australia
Background: There is growing interest in disinvestment within health services due to the potential to release resources for new practices and technologies and improve the overall quality of healthcare. However the term ‘disinvestment’ is used with various meanings and the practical implications for health services are not clear.
Objective: To systematically review the disinvestment literature to clarify definitions and identify issues relevant to development, implementation and evaluation of a disinvestment initiative within a regional health service.
Methods: A systematic search was undertaken in health databases and the grey literature. Critical appraisal was not undertaken as only case studies and discussion papers were identified.
Publications were summarised in themes: Conceptual/theoretical; Policy-related; Decision-making and implementation structures and processes; Expertise, training and resources; Organisational and management issues; Cultural; Professional roles and responsibilities; Financial; Values/ethics; and Research/evaluation.
Results: Most publications address the issue from a policy perspective and provide a statement of the problem, rationale for disinvestment or critique of existing processes. A small number described the implementation of disinvestment projects. Only five evaluative studies were identified, all case studies.
No overarching definition emerged. Some theoretical positions were advanced using ‘health economic’ or ‘rational decision-making’ models, however little practical information is available.
A pragmatic approach was used to develop definitions and a practical framework for a disinvestment process within an Australian health service.
Policy Implications: Consistency of definitions, further research and sharing of information from local settings is required if disinvestment is to be feasible in health services.
Getting from Surgical Threshold Productivity Metrics to Disinvestment by Commissioning Quality Improvement
(Abstract 0015)Bruce Willoughby1, Mark Lambert2
1Newcastle PCT, United Kingdom, 2NHS South of Tyne and Wear, United Kingdom
Background: Some surgical procedures have limited clinical value. The NHS Institute for Innovation and Improvement have published ‘productivity metrics’ on five such procedures. These suggested that our PCT cluster has high rates compared to the rest of England. These findings posed more questions: how does each of the five contribute towards this improved productivity, what are the costs of alternative treatments and what are the potential savings?
Objectives: To explore where the opportunities to reduce unnecessary procedures and develop a strategy for disinvestment where there is no health gain.
Methods: Rates of tonsillectomy, hysterectomy for heavy uterine bleeding and grommet insertion by GP practice (33) and the region’s PCTs (16) were examined over a three year period. Costs of alternative treatments were explored.
Results: Inter-GP practice rates varied by as much as 8-fold. Comparison with other PCTs suggests that savings of up to £800,000 could be made for our PCT cluster if the lowest rates in the region were matched. Costs of alternatives to these procedures are generally lower.
Policy Implications: The results suggested greatest impact by focusing on surgical teams, rather than influencing GP referrals or patient health seeking behaviour. We believe that by engaging with clinicians in quality is more likely to lead to successful disinvestment than focusing on performance data. Therefore, we have commissioned provider units in a programme of audit. Clinical teams must demonstrate adherence to evidence based pathways improving clinical practice. The net result should see disinvestment from these unnecessary procedures.
How to Re-Allocate Resources Within Services Through Data Benchmarking: Some Evidence From the Tuscan Health System
(Abstract 0035)Sabina Nuti, Milena Vainieri, Anna Bonini
Scuola Superiore Sant’Anna, Italy
Background: Tuscany Region has implemented a multidimensional system to assess the performance of all Local Health Authorities (LHAs), based on over 130 indicators classified in 6 dimensions. A study was carried out to use the results of this system to support health system decision makers to cope with resources scarcity. #
Objective: To quantify the amount of resources that LHAs can re-allocate, taking actions in different sectors, for services with more value for patients.
Methods: The analysis was based on data benchmarking of all indicators of the performance evaluation system that have an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each LHA and the best performance or the regional average. The second step was to measure this gap in terms of financial value.
Results: The results put on evidence that 6 to 10 percent of the regional resources (6,100 ml of euros) can be re-allocated if all institutions achieve the regional average or the best practice. Some LHAs are already efficient but others have large room for improvement: some of them can re-allocate up to the 13% of their total costs.
Policy Implications: The implications of this study can be useful for policy makers and the top management of LHAs in a public system that bases its action on cooperation more that competition. Benchmarking makes the system capable to measure the financial impact of different types of actions which can effect efficiency.