Authors' objectives:

The objects of this review are to make professionals in healthcare organisations (HCOs) aware of the economic dimension of quality, to provide information on the cost of quality and non-quality, and to propose working tools for measuring the cost of quality. This report also updates the ANAES report published in 1998.

Authors' results and conclusions: (i) Frequency of occurrence of deficiencies of quality of care. The data available for French HCOs pinpoint the most common areas of non-quality such as adverse events, unjustified interventions, and unjustified hospital stays. These areas represent potential savings through improvements in quality of care. (ii) Cost of deficiencies of quality of care. There are very few data for French hospitals, and poor study design makes them unreliable. Foreign studies have shown that deficiency-related excess costs vary according to type of deficiency. The most expensive are: infection generally, and postoperative infection; bacteraemia, pneumonia, drug-related adverse events, hospitalisations and inappropriate prescribing. (iii) Positive clinical and economic impact of interventions to prevent deficiencies. Studies published in France and abroad agree that the following may be useful: continuing quality improvement programmes, interventions to prevent nosocomial infections, and cost rationalisation programmes. There is evidence that these initiatives are profitable in the medium term, but no figures are available for the long term. (iv) Relationship between costs and quality of care. The studies analysed (none were French) found that the relationship is neither simple nor unique and that it depends on factors which are specific to HCOs, patients and the economic context of the analysis. (v) Working instrument. The working group developed worksheets as an initial working instrument. These worksheets are designed to encourage HCOs to measure frequency of occurrence and mean costs of some deficiencies of quality of care.

Authors' recommendations: Looking ahead: To remedy the lack of information, studies must be carried out in a representative sample of French departments and HCOs: (i) to measure the cost of the main deficiencies of quality of care; (ii) to measure the cost of investing in quality in order to encourage HCOs in their quality initiatives and embed their quality functions.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr

Copyright: Haute Autorite de Sante/French National Authority for Health (HAS)