A fifth of healthcare spending is wasted, says OECD report

Limb, Matthew

doi:10.1136/bmj.j215

Cited by 10 publications

(11 citation statements)

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“…The 21st century has seen an alarming increase in health-care costs, 1 and one of the major components driving this expenditure is unnecessary services. 2,3 In the US, Medicare alone spent a total of $4.29 billion on the top 25 lab tests in 2016. Among these, thyroid-stimulating hormone (TSH) was the fourth-commonest lab test, at a cost of $482 million for 21.5 million ordered tests, and thyroxine measurement the tenth-common, at a cost of $85 million for 7.1 million ordered tests.…”

Section: Introductionmentioning

confidence: 99%

<p>Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients — A Retrospective Analysis</p>

Dogra¹,

Paudel²,

Panthi³

et al. 2020

IJGM

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Background: In the US, serum thyroid-stimulating hormone (TSH) and thyroxine measurements are the fourth-and tenth-commonest laboratory tests ordered, respectively. Diagnosis of thyroid disorder requires clinical suspicion supported by laboratory values. However, in the setting of acute illness, both the clinical and laboratory pictures can be confounded. Objective: To study clinical outcomes and derangement patterns of inpatient thyroidfunction tests. Design: This retrospective study was conducted at an academic center on admissions aged ≥18 years and TSH tests performed over a 1-year period. Admissions with active pregnancy and/or prior thyroid-related diagnosis were excluded. Main Outcomes: Clinical outcomes were divided based on new diagnosis of thyroid-related disorder, newly prescribed thyroxine replacement, or antithyroid drugs/ endocrinology referrals, or both. In order to analyze the derangement patterns of abnormal TSH, only the results of the first test ordered were considered (as some admissions had multiple TSH tests ordered). Results: A total of 7,204 admissions aged ≥18 years had TSH tests done. Of these, 1,912 were excluded. Of the 5,292 admissions with no prior thyroid disorder or active pregnancy, 183 (3.46%) were assigned a new diagnosis of thyroid-related disorder, 54 (1.02%) received treatment/referral, and 46 (0.87%) received both a new diagnosis and treatment/referral. Based on the TSH results (reference range 0.42-4.0 mIU/L) of the 5,292 admissions, 4,312 (81.5%) and 980 (18.5%) admissions were flagged normal and abnormal, respectively. Of the 980 admissions with one or more abnormal TSH results, 21 (2.14%) had first ordered TSH <0.05 mIU/L, 855 (87.25%) admissions had first TSH result between 0.05-10 mIU/L, and lastly 104 (10.61%) were >10 mIU/L. Conclusion: There is low value in testing inpatients for thyroid disorders, and testing comes at significant expense to the health-care system.

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Section: Introductionmentioning

confidence: 99%

<p>Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients — A Retrospective Analysis</p>

Dogra¹,

Paudel²,

Panthi³

et al. 2020

IJGM

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“…On the other hand, cost escalating of health expenditure is a global problem [19,20]. Increasing national wealth alone does not necessarily increase national health [21,22]. Urinary lithiasis is one of the most common afflictions of modern society [23].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi

2020

Signa Vitae

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This study aimed to investigate the efficacy, safety and cost of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) for large proximal ureteral calculi. We retrospectively reviewed the outcomes of 205 subjects with ureteral stones size ≥ 1 cm from January 2011 to December 2017. We divided URSL into two groups including URSL + S with Stone Cone and URSL without Stone Cone. Ninety subjects were treated with URSL, fifty subjects were treated with URSL + S and sixty-five subjects were treated with PCNL. The success rate was 73.3%, 96.0% and 96.6% in URSL, URSL+ S and PCNL groups, respectively. The treatment time in PCNL group (77.3 ± 19.1 minutes) was longer than URSL group (42.0 ± 16.6 minutes) and URSL+S group (55.6± 20.3 minutes), and the hospital stay was longer in PCNL (9.5 ± 1.6 days) group than in URSL group (2.4 ± 4.8 days) and URSL + S group (2.0 ± 2.4 days). The cost-effectiveness ratio was 124.6, 159.1 and 135.3 in URSL, URSL + S and PCNL groups, respectively. In conclusion, Stone Cone could increase treatment success rate but incur higher cost. URSL is considered as the best cost-effective option, and the patients without medical insurance tend to choose PCNL because of high success rate of treatment.

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“…It is quite evident that the health care sector is not optimised sufficiently and may well never be. In a report by Limb [6], "Health economists have estimated that a fifth of spending on healthcare in countries of the Organisation for Economic Co-operation and Development is ineffective and have issued a call for action". Even if there were methods to fully optimise hospitals today, due to the rapid, ever-changing environment especially with respect to digital technologies, government policy and medical procedure advancement, there is a very strong need for an overarching framework for hospital capacity planning and optimisation which brings together all the parts of the hospital.…”

Section: Significance and Scopementioning

confidence: 99%

An Overview of Hospital Capacity Planning and Optimisation

et al. 2022

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Health care is uncertain, dynamic, and fast growing. With digital technologies set to revolutionise the industry, hospital capacity optimisation and planning have never been more relevant. The purposes of this article are threefold. The first is to identify the current state of the art, to summarise/analyse the key achievements, and to identify gaps in the body of research. The second is to synthesise and evaluate that literature to create a holistic framework for understanding hospital capacity planning and optimisation, in terms of physical elements, process, and governance. Third, avenues for future research are sought to inform researchers and practitioners where they should best concentrate their efforts. In conclusion, we find that prior research has typically focussed on individual parts, but the hospital is one body that is made up of many interdependent parts. It is also evident that past attempts considering entire hospitals fail to incorporate all the detail that is necessary to provide solutions that can be implemented in the real world, across strategic, tactical and operational planning horizons. A holistic approach is needed that includes ancillary services, equipment medicines, utilities, instrument trays, supply chain and inventory considerations.

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A fifth of healthcare spending is wasted, says OECD report

Cited by 10 publications

References 0 publications

<p>Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients — A Retrospective Analysis</p>

<p>Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients — A Retrospective Analysis</p>

Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi

An Overview of Hospital Capacity Planning and Optimisation

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