A scoping review on the production of different aspects of quality of health care

1.0 Research Aim

In order to deliver sustainable health and care services it is helpful to understand the relationship between different aspects of "quality" and costs of health care. Furthermore, it is important to understand how aspects of “quality” of health care are affected as a result of extra financial demands on the health care budget. The aim of this scoping document is to briefly summarise relevant literature examining the production of different aspects of health care “quality”, and on how extra demands on the health care budget impact on “quality”. The document also proposes an approach for estimating the marginal impact of expenditure on different aspects of “quality” using data currently being routinely collected in the NHS.

2.0 Motivation and background

The allocation of finite resources in the health budget amongst competing services requires that choices have to be made regarding which services are prioritised. The opportunity cost of increasing the provision of one form of health care is the loss of benefits resulting from the forgone opportunity to fund other services from the same amount of resource. Typically, economic evaluation of health care in the UK has focused on a single unit of outcome, the quality-adjusted life-year (QALY) (1). Recent research has estimated that, for every £13,000 extra spent on a treatment in the NHS, one QALY is displaced as a result of reductions in other services (2). This estimate of the NHS’ marginal productivity suggests, therefore, that, for a treatment to represent value for money, it must generate QALYs at lower than £13,000 per QALY. The QALY is a generic unit of health which captures both the quantity and quality of life generated by health care interventions. However, there are other aspects of quality of care that may also be considered an aspect of benefit which are not captured in the QALY. These are discussed in more detail in the next section.

The relationship between different aspects of quality of care is not well understood. For example, does improving access to health care also improve patient satisfaction? Furthermore, the link between different aspects of quality of care and costs is also problematic. The literature has discussed the possibility of a ‘U Shaped’ cost curve for quality. This suggests that, at lower levels of quality, improvements can result in cost savings from, for example, the prevention of costly adverse events; but, at higher levels, diminishing marginal returns to factor inputs set in resulting in higher quality becoming more expensive (3–5).

This project aims to undertake a rapid literature review to consider the following in the UK:

• The production relationship between the different aspects of quality of health care

• The relationship between different aspects of quality of care and cost

• The NHS’ marginal productivity with respect to different aspects of quality.