As Europe ages, the demand for healthcare will continue to rise. Yet the weak competitiveness of many European economies, low growth and high state debt means that little or no extra funds will be available for healthcare. This situation presents European health authorities and institutions with a stark choice: offer less care per head or raise healthcare productivity. Less care is essentially politically unacceptable, though in some cases it is bound to happen, so the entire sector has a productivity challenge. This challenge is many-faceted and includes subjects as diverse as:
- Improved surgical procedures, such as the use of Mohs techniques in treating skin cancer and the further deployment of minimally invasive approaches;
- Informed choices as to whether to offer specialist procedures or refer these to others;
- Consideration of the effect of medical, operational and financial risks;
- Use of alternative care paths that are cheaper than alternatives, without compromising on outcomes;
- Seeking economies through upscaling or outsourcing supporting disciplines and facilities. Examples include laboratories, hospital pharmacies, sterilisation facilities and interpretation of radiographic images.
Each of these topics requires some form of analysis of cost structure and/or integral cost. In many cases it is also necessary to consider the reimbursement regime.
We conduct analyses of cost structures, including process analyses and activity based costing where appropriate. The results help find leverage points for cost restructuring. Common themes include:
- Lower unit costs through logistic improvements, for instance in drug distribution or laboratory analyses;
- Variabilisation of cost, enabling better matching of cost to demand, for instance through outsourcing or the use of alternative technologies;
- Trade-offs between increased procedure cost (e.g. through more expensive materials) and reduction of the risk of complications or readmission.