How health systems can ensure value for money in addressing the elective surgical care backlog created by COVID-19

Overview

The length of waiting times for health services is a critical issue in all health systems. The COVID-19 pandemic has dramatically worsened waiting times for elective surgery and other health services. Health policymakers, in planning the recovery of their health systems from the pandemic, must now consider how best to improve waiting times but will, more often than no, have to do this efficiently, under the constraints of reduced fiscal space.

The Global Innovation Hub for Improving Value in Health, in preparing this report Beyond capacity management, how health systems can ensure value for money in addressing the elective surgical care backlog created by COVID-19, offers a framework of supply-side and demand-side levers for policymakers seeking to reduce national elective surgery backlogs in situations where opportunities for additional funding are limited. This rapid review of recent evidence, academic and grey literature indicates the need to reconceptualize the backlog issue and deploy policy levers beyond adding capacity and costs.

There are more policy levels available than it may at first appear. On the supply-side, policymakers can Optimize (improving the productivity and utilization of existing resources), Extend (drawing extra capacity from existing staff and assets), Expand (adding capacity), Coordinate (redeploying assets to match demand) or Reconfigure (reform treatment pathways and delivery modalities). With respect to the demand-side, we can Confirm (validate waiting list information and update our understanding of patient preferences for surgical or non-surgical intervention), Re-evaluate (agreeing and applying robust prioritization criteria), Rescope (to confirm the treatments we are offering deliver the right value for the costs and risks incurred) or Scan (to better understand patterns of unidentified and unmet needs that will have emerged during the pandemic). By considering a broader range of available levers, policymakers should be able to make material improvements to elective surgery waiting times and do this in an timely, fair and affordable way.