Economic analysis in patient safety: a neglected necessity

Healthcare quarterly ( …, 2006

Closer to home, we were apprised of some equally disturbing statistics reported in “The Canadian Adverse Events Study: The Incidence of Adverse Events Among Hospitals in Canada” (Baker et al. 2004). This study was developed by the Harvard Medical Practice Study and based ...

International Journal for Quality in Health Care, 2016

Purpose: To establish from the literature, cost of preventable adverse events (PAEs) to member states of the Joint Action European Union Network for Patient Safety and Quality of Care. Data sources: We searched MEDLINE, EMBASE and CINAHL for studies in Europe estimating cost of adverse events (AEs) and PAEs (2000( -March 2016)). Using data from the literature, we estimated PAE costs based on national 2013 total health expenditure (THE) data reported by World Health Organization and converted to 2015 Euros. Study selection/Data extraction: Information on type, frequency and incremental cost per episode or estimated cost of AEs was extracted. Total annual disability-adjusted life years (DALYs) resulting from PAEs in 30 EU nations were calculated using an estimate from a published study and adjusted for the percentage of AEs considered preventable. Result of data synthesis: Published estimates of costs of AEs and PAEs vary based on the care setting, methodology, population and year conducted. Only one study was from primary care, the majority were conducted in acute care. Nine studies estimated percentage of THE caused by AEs, 13 studies calculated attributable length of stay. We estimated the annual cost of PAEs to the 30 nations in 2015 to be in the range of 17-38 billion Euros, total DALYs lost from AEs as 3.5 million, of which 1.5 million DALYs were likely due to PAEs. The economic burden of AEs and PAEs is substantial. However, whether patient safety interventions will be 'cost saving' depends on the effectiveness and costs of the interventions.

SSRN Electronic Journal, 2000

2021

Every public expenditure, including saving lives or extending life expectancy of particular persons (target population), has unwanted but unavoidable side effects of statistical shortening of life expectancy of the general public. Therefore, cost-effectiveness analysis in making decisions regarding health and safety is an ethical necessity. We report here cost-effectiveness estimation based on comparison of three independent methods: (1) by analyzing salaries in risky occupations, (2) by assuming that people value their lives twice more than the wealth they earn, and (3) by comparing with the U.S. current legal practice. To the best of our knowledge, nobody applied method (2) to cost-effectiveness analysis. Our result is that the cost-effectiveness threshold for the developed countries is about US$60,000 +/- 25,000 per life-year (LY), or about 1.0 +/- 0.4 GDP (gross domestic product) per capita per LY. Therefore, a sum of not higher than US$85,000 (1.4 GDP per capita) is statistical...

Hematology-oncology Clinics of North America, 2002

The safety movement in health care, however, can be described as being dormant for many decades, with explosive interest and growth beginning in the mid-1990s. Although "first do no harm" has always been a primary guiding principle for physicians, there are many legal, cultural, logistic, and other barriers to obtaining an honest appraisal of the extent of preventable patient injuries and doing something about the understanding gained. A number of forces converged in the past 15 years to break down these barriers and question long-standing taboos. These forces include a relentless drive for cost containment by payors, changes in social mores that are moving decision-making authority to patients and groups of stakeholders (ie, away from the traditional paternalistic, physician-driven model), easily available information to all on the Internet, and an emboldened media that has kept celebrated cases of gross mishaps on the front pages. In addition, several relatively recent large epidemiologic studies of harm due to medical management have been picked up by the popular press and replicated in other industrialized countries with similar findings. Despite imperfect methodologies, the studies portray an unacceptable picture of a huge cottage industry that is morally and fiscally irresponsible.

Folia Medica, 2012

The critical problem of medical errors and the associated costs has recently been increasingly in the focus of attention of a number of world renowned experts. In the present article we review in detail and analyse the economic aspects of this problem. A methodology to assess the cost of medical errors and an algorithm for their prevention are presented. The cost of a medical error and the expenses required to avoid and prevent it are compared using graphical analysis of the prevention cost curve and the medical error compensation damages cost curve.

Journal of health services research & policy, 2011

Objective: To use cost data to estimate relative inpatient costs of hospital-acquired diagnoses.

The Journal of Legal Medicine, 2003

Infection, Disease & Health, 2018

Introduction: Increasingly, over the past decade, there has been a global shift in healthcare away from fixed "fee for service" payment mechanisms towards value-based reimbursement models rewarding safety and quality patient outcomes. Curbing the burgeoning costs of healthcare while incentivising higher quality and safer patient care are key drivers of this approach. At face value, this is clearly a worthwhile endeavour. However, there is a lack of conclusive evidence to support the effectiveness of such schemes where they have been introduced internationally. For this reason, Australia has largely been an observer of the shift in payment modalities that are occurring in other countries such as the United States and the United Kingdom. Method: This paper presents an overview of current Australian practice in pricing for safety and quality in Healthcare. Recommendations are provided to help infection control professionals prepare for the upcoming introduction of funding reforms aimed at reducing complications acquired in Australian public hospitals. Conclusion: The implications for infection control professionals are wide-ranging. This will be a period of significant adjustment for the public health system in Australia.

Theoretical Issues in Ergonomics Science, 2007

Patient safety-an old and a new issue 1. A bit of history Today, patient safety is considered as one of the most prominent issues in healthcare. Mass media very often insist upon it. Medical malpractices, adverse events in hospitals, human medical errors and their negative outcomes have become hot topics in magazines, newspapers and TV worldwide. The large press coverage and the diffusion of people's concerns have been developed quite recently; say, no more than 10 years ago. Consequently, patient safety is often, though wrongly, perceived as a new issue and, somehow, this perception corresponds to the reality. Indeed, patient safety is rooted in the practice and theory of medicine from its very origin. Every healthcare professional knows Hippocrates' principle: 'primum non nocere' (first, do no harm). The ethics and practice of every physician should be (and, hopefully, are) based on this principle. However, though embedded since the early days in the medical profession, patient safety was not of much concern for the people, notwithstanding they, sooner or later, inevitably, become patients. Although cases of supposed malpractice (and, sometimes, of severe punishments of wrongdoers) were frequently reported during the centuries, the awareness that medical professional activity might actually harm patients was practically unknown until the 19th century. Indeed, in 1867, Florence Nightingale, the founder of nursing science, in Notes on hospital, reported that: '.. . the actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases among patient treated out of hospitals lead us to expect' (quoted from Vincent 2006, p. 3). Some years earlier, Ignaz Philipp Semmelweis had already confirmed this statement by discovering that puerperal fever was caused by infecting particles on the hands of medical students and doctors contaminated in the autopsy room. His observations went against current scientific opinion, not to say, the opinion of medical doctors, who were not at all eager to admit that they caused many deaths. As one may notice, however, the issue of patient safety was still debated among healthcare professionals. The general public, in those years (and for many years to come) was more fascinated by the successes and discoveries in medicine, rather than by its faults.

2003

This paper constitutes considerations on methods of bringing the health care system of the 21st century to a state of maturity by posing the issues surrounding the high frequency of medical accidents and the growing prosperity of alternative medicine. There is a tendency to stress only the remarkable aspects of modern medicine, however, it harbors another aggressive, invasive side. This offensive is not only directed at the bodies of patients, but can at times be both a psychological and financial assault. Risk management is crucial to addressing this aggressive side of medical care. Studies in support of forefront medical science are necessary if medical technology is to be safely employed. This is linked to the establishment of the safety sciences in modern medical care. Moreover, medical professionals need to endeavor to ease the financial and psychological burdens of medical technology by making commonsense judgments from the perspective of those on the receiving end of such tec...

Journal of Risk and Financial Management

This paper introduces risk factors in the field of healthcare and discusses the clinical risks, identification, risk management methods, and tools as well as the analysis of specific situations. Based on documentary analysis, an efficient and coherent methodological choice of an informative and non-interpretative approach, it relies on “unobtrusive” and “non-reactive” information sources, such that the research results are not influenced by the research process itself. To ensure objective and systematical analysis, our research involved three macro-phases: (a) the first involved a skimming (a superficial examination) of the documents collected; (b) the second reading (a thorough examination) allowed a selection of useful information; (c) the third phase involved classification and evaluation of the collected data. This iterative process combined the elements of content and thematic analysis that categorised the information into different categories which were related to the central ...

Swiss Medical Weekly, 2012

Medical errors and adverse events are a serious threat to patients worldwide. In recent years methodologically sound studies have demonstrated that interventions exist, can be implemented and can have sustainable, measurable positive effects on patient safety. Nonetheless, system-wide progress and adoption of safety practices is slow and evidence of improvements on the organisational and systems level is scarce and ambiguous. This paper reports on the Swiss Patient Safety Conference in 2011 and addresses emerging issues for patient safety and future challenges.

The Joint Commission Journal on Quality Improvement, 2001

These include significant iatrogenic morbidity and mortality, 1,2 direct costs of additional required care, 3-5 and indirect, long-term costs of lost income, increased disability rates, and increased burden on caregivers. 6,7 Little is known about organizational costs associated with errors. This may be the case for at least two reasons. First, the analysis of organizational cost associated with errors is complex and does not have a framework that is specific to health care. Second, historically, these costs may have been thought to be trivial and their analysis not worthy of effort. Using two composite case studies of common preventable medical errors in this article we identify and categorize organizational costs of preventable medical errors, consider the impact of these errors on organizational performance, and provide a framework for further study. The details in each case study were drawn from a variety of actual cases. Case 1 Mr Smith was admitted to the medical unit of a physician practice-owned hospital for evaluation of dizziness The costs of errors can be far reaching, which should help make the "business case" for patient safety.

Optimizing Health: Improving the Value of Healthcare Delivery, 2006

Mistakes are at the very base of human thoughts, embedded there, feeding the structure like root nodules. If we were not provided with the knack of being wrong, we could never get anything useful done. We think our way along by choosing between right and wrong alternatives, and the wrong choices have to be made as frequently as the right ones. We get along in life this way. We are built to make mistakes, coded for error…The capacity to leap across mountains of information and land lightly on the wrong side represents the highest of human endowments"(1) finance and cost containment to safety and quality.