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“This review looked at productivity and efficiency in English non-specialist acute hospitals, which account for half of the total health budget, using a series of metrics and benchmarks to enable comparison. We conclude that there is significant unwarranted variation across all of the main resource areas, and although we found many examples of good practice, no one hospital is good at everything.

“We estimate this unwarranted variation is worth £5bn in terms of efficiency opportunity – a potential contribution of at least 9% on the £55.6bn spent by our acute hospitals. The report makes 15 recommendations designed to tackle this variation and help trusts improve their performance to match the best.”

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“This analysis demonstrates that for the first 11 months after implementation, the EBI [Evidence-Based Interventions] programme did not successfully achieve its aim of accelerating disinvestment for the low value procedures under its remit. Conversely, on the understanding that the control group provides a counterfactual scenario whereby the EBI programme did not exist, we found statistically significant evidence that the implementation EBI programme was associated with a small increase in the volumes of low value procedures under its consideration. This finding is consistent irrespective of whether we change the composition of the treatment group according to procedures with estimated potential annual savings of above or below £10 000 000. When analysing organisational and financial factors which may have influenced implementation of the EBI programme, we found that CCGs [Clinical Commissioning Groups] which posted a deficit in the financial year before implementation had larger reductions in low value procedures than CCGs which did not. This may be because CCGs which posted a deficit in the year before implementation felt the need to more pro-actively engage with the EBI programme as one mechanism to save costs and reduce their deficit in the subsequent year. Despite approximately a third of CCGs volunteering to be part of a demonstrator community which trialled EBI recommendations before implementation, there were no significant differences between changes in volumes of low value procedures between demonstrator and non-demonstrator CCGs. Finally, we found that NHS hospitals had significantly larger reductions in low value procedures than independent sector hospitals. This may be because NHS hospitals have an institutional culture which is more amenable to NHS England-led national quality improvement initiatives, whereas independent sector hospital hospitals may be more motivated by their respective corporate-level objectives and strategies.”

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“Differences in administrative expenditure at the level of individual health care providers, such as hospitals and individual clinicians, are less studied. Of those nations where data allow for a comparison of administrative costs in health care organisations, Scotland reported the lowest share, at 11.6% of total hospital costs, whereas this figure was more than double in the United States (Himmelstein et al., 2014). Demarcating costs related purely to administration in health care facilities is challenging, though, because many functions have both an administrative and a clinical purpose. Administrative costs of health providers also vary within countries. For instance, a recent report analysing variations in productivity and performance in NHS England finds that costs for corporate and administrative staff vary between 6-11% of total income among NHS England trusts (Department of Health, 2016).”

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“In many countries, evidence exists for the overuse of aggressive care for dying patients and simultaneous underuse of appropriate palliative care. Despite evidence that the majority of people around the world would prefer to die at home,^141–46 about half die in hospital worldwide, with considerable variation among countries.¹⁴⁷ Inappropriately aggressive cancer care near the end of life has been identified as a common problem in Canada,¹⁴⁸ the USA,¹⁴⁹ and the UK,¹⁵⁰ with regional variations observed.¹⁵¹ Overuse of aggressive end-of-life care in the UK, for example, includes futile insertion of percutaneous endoscopic gastrostomy tubes¹⁵¹ and administration of chemotherapy that hastens death.¹⁵² Furthermore, ineffective intensive care unit treatment at the end of life has been reported in Canada,¹⁵³ the USA,¹⁵⁴ and Brazil.¹⁵⁵ A study from Korea found that the majority of terminal cancer patients received futile intravenous nutrition during the last week of life, with discussions of palliation in only 7% of cases.¹⁵⁶“

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“A review in the United Kingdom estimates that for every 10,000 British women aged 50 years invited to screening for the next 20 years, 43 deaths from breast cancer will be prevented and 129 cases of invasive and non-invasive breast cancer will be overdiagnosed and treated (Independent UK Panel on Breast Cancer Screening, 2012).”

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“● Inappropriate ED visits account for nearly 12% of ED visits in the United States and England, 20% in Italy and France, 25% in Canada, around 30% in Portugal and Australia, and 56% in Belgium (Berchet, 2015).⁷
“● In England the cost of inappropriate ED visits was estimated at nearly GBP 100 million between 2011 and 2012 (McHale et al., 2013), and in the United States at around USD 38 billion yearly (NEHI, 2010).”

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“Echocardiography was consistently overused, for instance in ‘routine perioperative evaluation of ventricular function with no symptoms or signs of cardiovascular disease’, whereas other tests (urinary cultures, upper endoscopy and colonoscopy) were overused at varying rates. The overuse of echocardiography was studied in the UK⁵¹ and the Netherlands.⁵² The rates of overuse varied between the two settings: between 77% (Netherlands) and 92% (UK).”

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Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated Jan. 5, 2023 by Doug McVay, Editor.