Introduction
Public health systems are under intense pressure to meet increasing demand for health care in environments of considerable and increasing financial resource constraint(1). In order to continue to meet the current and future health services needs of the public there is a need to maximise health outcomes given limited public healthcare expenditure, a requirement which may also be described as efficiency improvement. Many policy suggestions to improve efficiency are based on expenditure-reducing “cost containment” initiatives, seemingly without much consideration for impacts on care quality in terms of patient outcomes and health service delivery(2,3). We argue that such short-term, silo-based efficiency improvement approaches might not always result in improvements in patient outcomes or service delivery regardless of financial impact. We further argue that there is a need to focus on approaches that can potentially improve both efficiency and health outcomes concurrently. This paper identifies and discusses approaches to improving efficiency in public health systems which are identified as having evidence of success in enhancing both financial and health service outcomes.
Public health system efficiency and quality is challenged by factors including tightening budgets, growing demand, professional shortages, increasing disease burdens, increasing pressure on infrastructure, technological implications, changing service models and changing service accessibility(4). An ongoing state of inefficiency amidst an environment of seemingly-constant reform is characteristic of the public health systems of many well-developed countries around the world(5,6). Compounding this state is a common trend in rates of growth in health services demand in excess of funding growth rates, creating further pressure on already-burdened public health systems(7). Continuing with business-as-usual approaches is likely to result in further compounding of risks to health system sustainability. The ability of public health systems to continue to meet these increasing pressures may not be sustainable without changes with a combined focus on efficient use of resources and service delivery optimization.
The links between care quality, care outcomes and the investments required to achieve them are well-embedded in models of health care efficiency(8). Despite this longstanding focus, the literature on approaches to supporting efficiency and quality improvement in public health systems is disparate and non-cohesive, with a range of isolated approaches described rather than a consensus on a single best-practice approach. We suggest that there is an urgent need to consolidate understanding around efficiency improvement approaches that have been effective internationally in order to support efforts to improve health services quality and efficiency using evidence-based, best-practice approaches.
This study was undertaken in order to identify and explore what is currently known and what approaches are currently in place for supporting efficiency improvement in public health systems. There is an identified gap in the literature on this topic towards which this synthesis adds new knowledge. This paper aims to provide a consolidated view of the existing evidence to inform public health decision-making on evidence-based approaches to supporting efficiency and quality improvement. We suggest that applying the findings of this study as a framework for policy-setting and decision-making can support efficiency improvement approaches across public health systems.