EFFICIENCY DEFINITIONS
Each of the six aims of the Institute of Medicine has inspired research or standards, except efficiency. The AAAHC has measured the cost of performing certain procedures and determined factors that make some institutions more efficient than others, and the NQF sponsored a panel on efficiency at its annual meeting. Other organizations (AHRQ, NCQA, RAND) have begun to think, but concrete action is missing.
DEFINITIONS: Efficiency will be defined as "Cost per unit service provided." Within cost, we will include both time and money, because they are not always equivalant. (Who's time and who's money?) We must also look at macro-efficiency and micro-efficiency. On a macro level, consider the care of populations or groups of patients with a common disease or condition. Micro-efficiency looks at individual patient care or procedures. It is possible to be efficient on the micro level but inefficient on a macro level. One might perform an angioplasty very efficiently on a patient who shouldn't have neede the procedure if the larger shystem has been more successful at convincing him to change his lifestyle. One must also be careful to distinguish between efficient and cheap. Not always easy.
Between 30 and 50% of healthcare expenditrues have been ascribed to waste. However, efficiency will not solve problems of overuse. (Is this a problem or a value judgement?)
Finally, we must take a long term view in looking at costs. It may seem "efficient" to ignore otitis media in the moment, but what about the kid's hearing six years later?
Comments
I think you are on the right track Dr. Burney.
The one comment I would make is that overuse is an efficiency problem. By correcting the underuse or overuse, the system gets more efficient. The system has to be defined, but in my mind as a patient, it is what happens to me from first contact until any post-discharge activities prescribed or recommended by the care giver.
Posted by: Mickey Christensen | November 9, 2005 03:25 PM
Cost and efficiency are in the eye of the beholder. Tell me where you want to go and I'll tell you how to get there.
Few care about efficiency. Many care about cost. Why not focus on cost and choose a definition that encourages a look upstream as well as down. I mean where the hell are all our health care dollars going anyway! And what about quality? As ethereal as it may be, can't talk about cost and efficiency without directly or indirectly talking about quality.
Posted by: john williams | November 11, 2005 11:47 AM
Contextually speaking quality and efficiency are relative depending on the "health care life-cycle" you view. If you are overprescribing antibiotics you may be still giving cost-effective and efficient treatment to a patient or a class of patients, but at a macro-level over a few generation one can land with a whole problem of antibiotics no longer being effective or loss of natural resistance in individuals to name a few. Cost-effectiveness and efficiency of its delivery then also relate to the whole approach to health care itself. This also applies at both mental and physical level as the scocietal context in which man lives changes with time.
Posted by: Azad Verma | December 22, 2005 05:02 AM
Exactly the point, Azad. When talking about efficiency, it is important to define the setting--macro vs micro. However, these worlds are not always in conflict. Those advocating greater use of technology in healthcare (www.hhs.gov/healthit/)argue that it will reduce the cost in the practitioner's office AND make healthcare more efficient for the population.
Posted by: Robert Burney MD | December 22, 2005 07:48 PM