When we speak of cost containment we are not referring to maintaining the level of costs within previously established limits that are compatible with the sustainability of the health system.

Being aware of cost containment implies being aware of all aspects related to expenditure, the costs of each of the items: personnel, material, investments, processes, etc. 

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The strategies related to cost containment are related to the need to reduce the consumption of health services, the reduction of reimbursements per service and the reduction of indirect costs.

The use and combination of these strategies can negatively affect access to health services, the quality of services provided or the results measured in terms of health.

Health outcomes are often difficult to measure and tend to be costly in terms of the time required to arrive at correct figures.

Limiting access to health care

These are essentially measures that are contrary to the spirit of our health system and are related to strategies to reduce the costs of direct care.

In liberal systems, insurance companies limit access to their services by raising the costs of insurance policies, limiting coverage and service portfolios. Policyholders can incorporate these services after increasing payments for services, which is an incentive for customers to use these services.

It is well known that this is detrimental to health outcomes, given that the first trend to be eliminated by health service applicants is the demand for all activities and services related to health promotion and prevention activities, focusing primarily on all that is directed at the processes of illness.

Unnecessary attention

Unnecessary attention can be easily defined in the various services provided, but we must also recognise that acceptance of the superfluousness of these services is equally difficult to accept. 

Therefore, unnecessary health care requires in-depth studies, coordination between the different services provided, evaluation of health costs and outcomes, establishment of the most appropriate place and form of service provision, etc.

Prevention

Although this is the most important point when it comes to establishing measures to contain spending, it is nevertheless the most appropriate measure to achieve this end without damaging the various aspects of health care provision. It is true that the results are achieved in the long term, and this is incompatible with the current way of making decisions in the political sphere.

The use of primary care

Primary care is closely related to prevention and health promotion and although these are more long-term outcomes, any of its activities are more cost-effective than the health processes associated with the pathologies that trigger hospital care.

Without a doubt, the commitment to primary health care reduces costs due to a decrease in the number of visits and the consequences of the use of hospital care.

Objective, costs

Being fully aware of all the aspects and implications of the health care processes, professionals should

– Know the costs: be aware of and responsible for the expenses incurred in each health care process.

– Monitoring costs: this is related to establishing precise budgets, knowing when, where and how they will be incurred.

– Cost management: knowing what and how it can be done to control and manage each expenditure item. 

– Control incentives: establish incentives for all actions that involve control and good management of costs.

– Cost avoidance: through knowledge of everything that is superfluous to the health system and the provision of services, material, technology, etc.

– Cost reduction: through knowledge and orientation towards process efficiency.

– Cost control: through the efficient use of resources.

– Permanent cost-benefit analysis: what we contribute and how we contribute at any given time to health, its maintenance or recovery. 

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