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Tackling Wasteful Spending on Health

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Following a brief pause after the economic crisis, health expenditure is rising again in most OECD countries. Yet, a considerable part of this health expenditure makes little or no contribution to improving people's health. In some cases, it even results in worse health outcomes. Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report systematically reviews strategies put in place by countries to limit ineffective spending and waste. On the clinical front, preventable errors and low-value care are discussed. The operational waste discussion reviews strategies to obtain lower prices for medical goods and to better target the use of expensive inputs. Finally, the report reviews countries experiences in containing administrative costs and integrity violations in health.

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Producing the right health care: Reducing low-value care and adverse events

Value measures the health outcomes that matter to patients for every dollar spent. Health services that fail, for avoidable reasons, to maximise outcomes given available resources can be considered wasteful clinical care. Strong evidence exists that it persists in health care systems. Wasteful clinical care manifests itself in many forms: as avoidable adverse events and as care that is ineffective, inappropriate or poorly cost-effective – from the diagnosis of cancers that will not cause harm, to the sensitive matter of providing futile care near the end of life.This chapter begins by describing the extent of wasteful care and exploring its drivers. Persistent challenges include a lack of metrics to quantify wasteful care and the need to sustainably engage both clinicians and patients to change practices. The chapter concludes by discussing the information systems needed to detect wasteful care and the policy levers to tackle it.

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