04 Mar NHS Sees Reductions In Low-Value Procedures
MedicalResearch.com Interview with:
Honorary research Fellow
Department of Primary Care and Public Health, Imperial College London
Consultant in public health
Centre Medical Directorate with Bupa, United Kingdom.
Medical Research: What is the background for this study? What are the main findings?
Dr. Coronini-Cronberg: From April 2011, England’s National Health Service (NHS) was challenged to find £20 billion of efficiency savings over four years, in part by reducing the use of ineffective, overused or inappropriate procedures. However, there was no clear instruction as to which procedures are of ‘limited clinical value’ and also under which circumstances they should be reduced. We looked at hospital admissions statistics for six procedures that appear on local and/or unofficial lists to see which had been affected and whether cuts were applied consistently across commissioners in the first year of the savings programme.
We found a significant drop in three procedures considered potentially ‘low value’ compared to the underlying time trend: removal of cataracts, hysterectomy for heavy menstrual bleeding, and myringotomy to relieve eardrum pressure. There was no significant change in three other ‘low-value’ procedures: spinal surgery for lower back pain, inguinal hernia repair, and primary hip replacement, or in two ‘benchmark’ procedures (coronary revascularisation, gall bladder removal).
Myringotomy, a procedure to relieve pressure in the ear which is considered relatively ineffective, declined by 11.4 per cent overall. Two procedures considered only effective in certain circumstances also fell overall. Hysterectomy for heavy menstrual bleeding declined by 10.7 per cent overall, and cataract removal declined by 4.8 per cent.ý
ýWe also found the reductions were inconsistently applied by commissioning groups (so-called Primary Care Trusts).
Medical Research: What should clinicians and patients take away from your report?
Dr. Coronini-Cronberg: The NHS is a taxpayer funded universal healthcare system. To drive value, maximum health output needs squeezed from each pound invested. The data suggest the NHS may indeed be managing costs in a rational way by reducing some procedures that have limited or low clinical value. However, we cannot be sure that it is those patients who would not benefit from surgery that are being excluded.
However, our research reveals a lack of consistency between commissioning organisations regarding which procedures were cut. With little national guidance about which procedures to remove or restrict funding for and under which circumstances, commissioners may be turning to locally developed, unofficial lists and criteria of low value treatments. This urgently needs to be addressed to avoid local variations. Arbitrary decision-making needs to be replaced with objective, consistent, evidence-based policies.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Coronini-Cronberg: At the time of undertaking our study, data was only available for the first year of the savings programme. Useful future research would investigate if these initial trends were sustained and also if the other procedures also showed declines. Our study design also did not allow us to monitor whether any reductions in procedure rates were only among those patients who would have been unlikely to benefit from surgery or whether it was a uniform reduction. This also has important implications for maximising health value: making sure the right patients are receiving the right treatment.
English National Health Service’s Savings Plan May Have Helped Reduce The Use Of Three ‘Low-Value’ Procedures
Sophie Coronini-Cronberg, Honor Bixby, Anthony A. Laverty, Robert M. Wachter, and Christopher Millett
Health Aff March 2015 34:3381-389; doi:10.1377/hlthaff.2014.0773
MedicalResearch.com Interview with: Sophie Coronini-Cronberg (2015). NHS Sees Reductions In Low-Value Procedures