The Economics of Patient Safety: Adopting a Value-based Approach

By John Tingle

The OECD (Organisation for Economic Co-operation and Development) have recently published a report on the economics of patient safety.The report is in two main sections, section 1, the cost of failure and section 2, reducing harm effectively and efficiently.

Section 1 focuses on a review of the literature in the area. The reports begins by making the point that health care has always been and continues to be, a risk-laden activity:

“While modern medical sciences can certainly do more, the risks of complication, error and harm are commensurately greater.” (p.9)

The report states that adverse health care events can happen at any point of the patient’s journey and can vary between care settings. Similar causative factors can be attributed to most types of harm.On the world patient safety stage, the report states that despite global efforts to reduce the burden of patient harm in developing countries, the situation does not appear to have changed over the past 15 years. WHO data is cited from 2000 which indicates that two –thirds of all adverse events occurred in low-and middle income countries. The risk of patient death as a result of an adverse event appears to be much higher in developing countries with some estimates suggesting that as many as one in three adverse events result in the patient’s death. The report does suggest some ways forward in avoiding adverse health care events in developing countries.

It’s stated in the report that as much as one USA dollar in seven is spent treating the effects of patient harm in acute care. Costs related to adverse events occurring in hospitals range between 1.3 per cent and 32 per cent of public hospital spending. Healthcare –associated infections alone cost NHS England almost £1 billion every year or 2.6 per cent of the public hospital spending. In 2008, the economic cost of medical error in the US was estimated to be almost 1 trillion USD.

A conclusion can be drawn that the costs of harm can dwarf the costs of preventing it. The reports also looks at pressure area care and prevention costs for pressure ulcers are lower than treatment costs. Improving patient safety in US Medicare hospitals is estimated to have saved 28 Billion USD between 2010-2015.The costs of patient harm can also cascade into the political economy, public trust in the health service can be compromised. As well as reputational costs there can also be political costs of patient error to health organisational leaders, regulators and politicians.

Section 2: Reducing harm effectively and efficiently

This section of the report provides an overview of the underlying causes of harm, and the ensuing strategies, interventions and practices to improve patient safety. A snap shot survey of experts on the costs and impacts of a range of patient safety interventions is given with recommendations to policy makers and providers of care given on a value based approach.This report makes a very valuable contribution to patient safety literature. It is interesting to see patient safety viewed from an economic value perspective

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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