Summary Q&A
191
countries has on the whole been worth it, even in the presence of significant waste, due to the high value attached to health gains achieved through medical advances. The major policy challenge is that while health systems at their best can provide life-saving care, they also often have a large amount of waste. The policy imperative is to cut one without cutting the other. 10. What are the main sources of waste, and how should these be addressed? Excess hospital infrastructure and inefficient spending on pharmaceuticals are both major sources of waste. There are nearly twice as many hospitals per person in the Commonwealth of Independent States region as in the EU-15. The result is high fixed costs, unnecessarily long admissions, and hospital beds that are occupied for the wrong reasons: for example, in many ECA countries, people are far more likely to be hospitalized for hypertension than in the EU-15, a condition that should be controlled at lower levels of care. Often, the major constraint to reducing hospital capacity is political will, but there are countries in the region, such as Estonia, that have successfully made these reforms. Ultimately, it is in the interest of the health system and patients alike for a population to spend less rather than more time in hospital. With regard to pharmaceuticals, governments across the region are struggling to contain the pressure that these exert on their budgets. One challenge is high prices. In many countries, there is scope for procurement reform and for more “smart purchasing� of drugs. This may include a preference for generics, price regulation, and innovative contracting approaches. Another problem is overconsumption, for which both providers and patients bear some responsibility. Clear treatment protocols, drug lists, and generic promotion can help. A significant and sometimes overlooked part of the agenda for cutting back on waste is not about pursuing major systemic reforms but rather about understanding why, for example, some doctors refer more patients to higher levels of care, order more diagnostic procedures, or prescribe more drugs than their colleagues. The same applies to why some hospitals have higher readmission rates or higher mortality rates for specific types of care than others. The organizations that pay for services should keep track of these patterns and make use of this information to address the outliers through more active approaches to purchasing care. Investing in the analytical capacity to fulfill this role can play a key part in setting the stage for efficiency gains.
GB.indb 191
22/05/13 7:29 PM