Health care efficiency is a comparison of delivery system outputs, such as physician visits, relative value units, or health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. An alternative approach is to look at latency times and delay times between a care order and completion of work, and stated accomplishment in relation to estimated effort.
One difficulty in creating a generalized efficiency measure is comparability of outputs. For example, if hospital A discharges 100 people at an average cost of $8000, while hospital B discharges 100 at $7000, the presumption may be that B is more efficient, but hospital B may be discharging patients with poorer health that will require readmission and net higher costs to treat.
Measures of efficiency
Bloomberg Health-Care Efficiency Index
The Bloomberg index calculates an efficiency score based on a nation's life expectancy along with relative and absolute health expenditures. In 2016 Bloomberg ranked Hong Kong as the nation with the most efficient health care. The US was 50th on the list of 55.
The method has been described as being "very simplified". An economist from Nuffield Health criticised the index for not taking into account quality of life: "Diet, smoking rates, standards of living and public services more generally will all have a powerful effect on life expectancy. On the other hand, many of the most common and important operations carried out, like cataract procedures to save eyesight, wouldn't have any effect on lifespan."
Targets to increase efficiency
Market dynamics
Increasing information
In general consumers are motivated to pursue the best value in a market. The health care market is complicated by the fact that pricing and quality are opaque, consumers don't usually pay the full cost of care, and health is considered a "priceless" asset.
Efforts to increase market transparency include hospital reporting requirements and insurers offering their customers estimates of provider costs for particular conditions.
Simplifying information
Efforts to simplify market information, steering participant decision-making to achieve better efficiency can include regulations like those associated with the Affordable Care Act insurance market creating minimum standards on what each plan can offer as well as placing them into "gold", "silver", or "bronze" categories.
Cost sharing
Cost sharing refers to various schemes to ensure health care resources aren't overused. In many health systems, the patient doesn't bear the full cost of services. If the person making the purchase decision effectively sees no cost, the demand for that service would tend to rise. In health care this could manifest as emergency room visits for minor ailments that could be managed through other less expensive remedies like primary care or nursing hotlines.
Common cost sharing mechanisms include copays, deductibles, and health savings accounts.
Prospective Payment System
A prospective payment system, which is used by Medicare in the United States, is a popular way to incentivize hospitals to reduce cost. A common way to structure the system is to pay hospitals and healthcare centers a pre-determined amount based on the national average cost of treating patients in a given, similar group, as classified by type of healthcare administered. For example, if a hospital spends less money per patient than the national average, then they would be able to keep the surplus. Similarly, if the hospital spends more per patient than the national average, they would incur that difference as a loss on their balance sheet.
Potential Tradeoff Between Cost and Quality of Care
An additional complication when evaluating cost efficiency in healthcare is the potential tradeoff with the quality of healthcare. The researchers Paul L.E. Greico and Ryan C. McDevitt argue that policies aiming to improve cost efficiency through incentivizing hospitals to reduce costs may inadvertently affect health outcomes or the quality of care administered. Their research analyzed the dialysis industry to ascertain whether its reliance on the Medicare prospective payment system incentivizes hospitals to sacrifice the quality of care administered in order to reduce costs. Other studies have found that the policy has had no negative effect on healthcare quality outcomes.