Tackling Wasteful Spending on Health, OCDE, 2017

ocde

A OCDE publicou um estudo sobre desperdício na despesa da saúde nos países membros (Tackling Wasteful Spending on Health). Um relatório extenso (mais de 300 paginas), com sumário de 12 páginas.

São apontadas sete áreas com excesso de despesa e com eventual prejuízo na saúde das pessoas, grupos e populações. Os números para a OCDE nas áreas reportadas são:

  • 10% de intervenções desnecessárias e infecção adquirida nos serviços de saúde;
  • 10% da despesa hospitalar é afecta a correcção de erros ou infecções adquiridas em serviços de saúde;
  • 33% das crianças nascem por cesariana, sendo o número possível de 15%;
  • a variação da penetração de consumo de genéricos é entre 10 a 80% do total dos fármacos;
  • 20% das urgências em Portugal são inapropriadas;
  • as perdas por erros e fraude são em média de 6% da despesa dos serviços de saúde.

Na análise realizada Portugal apresenta melhores indicadores em admissão ao hospital relacionada com problemas de diabetes e no financiamento do sistema de saúde. No entanto, não estamos bem nas infeções adquiridas nos serviços de saúde e na utilização dos serviços de urgência.

Health care systems in OECD countries continue to improve health and increase life expectancy. Yet the financial cost is high, and countries struggle to meet the demands for more spending. New treatments are often expensive, and ageing populations have ever greater needs. A significant share of health spending in OECD countries is at best ineffective and at worst, wasteful.
Wasteful health care spending is common

  • Overall, evidence suggests that up to one-fifth of health spending could be channelled towards better use. Numbers show that:
    • Many patients are unnecessarily harmed at the point of care or receive unnecessary or low-value care that makes no difference
    to their health outcomes.
  • • The same benefits could often be provided using fewer resources. For instance some health systems are poor at using generic drugs; others provide care in expensive places such as hospitals, rather than in more cost-effective settings.
    • A number of administrative processes add no value, and money is lost to fraud and corruption.

With over 9% of GDP spent on health care systems across the OECD, three-quarters of which is paid for by governments, such waste undermines the financial sustainability of our health systems.

Substantial cuts in ineffective spending are necessary
Acknowledging the existence of ineffective spending and waste is never easy – be it for health workers, managers, patients, and even for decision makers. But opportunities exist to release resources within health care systems to deliver better value care.
Cutting ineffective spending and waste will produce significant savings. For policy makers struggling to cope with ever-growing health care expenditure, all opportunities to move towards a more value-based health care system must be pursued.

Wasteful spending can be tackled
Actions to tackle wasteful spending are needed in the delivery of care, the management and organisation of health services, and in the
governance of health care systems. Strategies to curb wasteful spending must reflect two principles:
• Stop spending on things that do not improve health – for example, unnecessary surgeries and clinical procedures.
• Swap inputs and change approaches when less pricy alternatives of equal value exist – for example, by encouraging the use of generic drugs, developing advanced roles for nurses for chronic patient management, or ensuring that patients who do not require hospital care are treated in less resource consuming settings such as primary care.

Five ways to tackle wasteful care
1. Robust information systems are required to identify low-value care. At least ten countries produce atlases to identify variations in health
care activities that may not be medically justified.
2. Reporting systems of adverse events need to be more transparent and oriented towards learning. New Zealand stands out: in addition
to hospitals, ambulance services, hospices, elderly residential care organisations, and other non-hospital providers have such systems.
3. Information and behaviour change campaigns that target both clinicians and patients have a key role to play. The Choosing Wisely® campaign is a clinician-led initiative aiming to reduce low-value care by encouraging patient-provider conversations about whether specific services truly add value. It is now active in at least a third of OECD countries.
4. Clinical guidelines can improve the process and outcomes of care, reduce the use of unnecessary interventions and save costs. In the United States, an evidence-based programme for patients with non-small cell lung cancer found outpatient costs were reduced by 35%.
5. Financial incentives and nudges create behaviour change. In the Australian state of Queensland, health authorities withhold payments to hospitals for six “never events”. Nineteen OECD countries use Health Technology Assessment to help determine the value of some new treatment options.

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