Disinvestment for re-allocation: A process to identify priorities in healthcare

Abstract

Resource scarcity and increasing service demand lead health systems to cope with choices within constrained budgets. The aim of the paper is to describe the study carried out in the Tuscan Health System in Italy on how to set priorities in the disinvestment process for re-allocation. The analysis was based on 2007 data benchmarking of the Tuscan Health System with an impact on the level of resources used. For each indicator, the first step was to estimate the gap between the performance of each Health Authority (HA) and the best performance or the regional average. The second step was to measure this gap in terms of financial value. The results of the analysis demonstrated that, at the regional level, 2-7% of the healthcare budget can be re-allocated if all the institutions achieve the regional average or the best practice. The implications of this study can be useful for policy makers and the HA top management. In the context of resource scarcity, it allows managers to identify the areas where the institutions can achieve a higher level of efficiency without negative effects on quality of care and instead re-allocate resources toward services with more value for patients.

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

“…In Tuscany, a benchmarking exercise including GP and pharmaceutical expenses, inappropriate hospitalisation rates, hospital length of stay and readmission rates estimated that savings equivalent to 2-7% of the health-care budget could be achieved if all health authorities achieved the regional average. 39 However, this finding is based on the questionable assumption that the regional average is desirable and has best outcomes for patients.…”

“…looking at clinical practice variations). 39 There have also been suggestions that the criteria for assessing disinvestment candidates could be adapted from established criteria used to assess new technologies (e.g. the criteria used by NICE).…”

“…39,46 Much recent work in the UK has focused on benchmarking hospitals on outcomes such as mortality or surrogate outcomes such as reoperation rates in an attempt to identify low-quality care. 198,199 This outcomes benchmarking is fundamentally different from the process measure benchmarking we undertook on procedure rates.…”

“…12,[35][36][37][38][39] Many countries have emulated the NICE process for evaluating new technologies to ensure that they are safe, clinically effective and cost-effective before diffusion. However, most are struggling to develop any structured process for identifying medical technologies which might be overutilised in patient groups where they offer little benefit.…”

“…77 However, these 'usual suspects' might not be most relevant locally. Instead, benchmarking 39 a broad range of local procedure rates against the national norms might provide a more flexible way to identify areas where local service provision is inappropriately high or inefficient. The recent development of the NHS Atlas of Variation in Healthcare 45 and similar tools allow commissioners to readily benchmark local health-care provision.…”