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.