It may sound like a paradox, but in functional, vertically organized clinics and primary healthcare units, increased cost control usually increase overall cost since the patient goes through several functions within the chain of healthcare.
Also, what is the probability that all functions will meet their respective budget, when the flow of patients cannot be controlled? The easiest way to cut or control cost is to stop receiving patients or temporary close care units, regardless of whether there is a need for healthcare.
Today, there is also a large portion of “referral healthcare” for non-emergency care, as well as for comorbidity. Patients are moved around to various functions due to unclear responsibility, budget cost control or lack of beds. Treating a given number of patients leads to a pre-determined cost per clinic, since the cost per treatment is more or less constant. Consciously or unconsciously the clinics are incented to keep the number of patients as low as possible. Otherwise the budget will be exceeded. In return this results in longer lead times for the patient.
Is this an adequate behavior both financially and with regard to social benefit?
If we instead play with the idea that there is only limited money for a hospital or a county, but they have the ability to continuously allocate resources between the clinics and other functions based on changing patient needs and flow. How would the hospital or county be managed then?
We let the patients and patient flows control our operation, in which an important part is that the patient should not have to return. If there is a need to come back, the responsibility lies within the last responsible care unit. The patients themselves do not need to start all over again, getting last in line at the beginning of the chain of care and then try to get through again via a number of different functions, where each stop cost money without necessarily getting any healthier.
We ask ourselves how we should manage, throughout the chain of healthcare, as many patients as possible and allocate and shift resources to where they are most useful.
– The best and most relevant competencies will enter as soon as possible in the treatment process. Not at the back of the chain after all less qualified have made their attempts.
– We split up the work into care related and administrative and supportive work, respectively. The healthcare educated personnel focus on healthcare associated work.
– Let lead time rather than cost be the variable we constantly focus to improve.
Focus on cost per clinic or healthcare center will result in increased costs in a holistic perspective and also long lead times for each patient. The longest lead times are also taken place outside the hospital’s doors. By moving the focus from cost to lead time, and continuously focusing on shortening lead times for patients, this enables an efficient flow through and outside the hospital. This, in turn, leads to cost effective healthcare and ensures patient safety.
