Claims that up to €8bn can be saved on healthcare spending require a second look, says Barend van Lieshout.

As a figurehead of consultancy group Booz&Co, Ab Klink can generate a lot of media attention. There is, he says, between €4bn and €8bn (13-27%) to be saved on hospital care.

This saving can be achieved via a cocktail of measures to get the treatment-happy medical sector back on the quality track. Unfortunately, Klink falls into the same trap as the one he’d like to rescue medical specialists from: he is advising they carry out a far-reaching operation with uncertain results without weighing up the alternatives.

Operate or wait?

As we all know, production in the healthcare sector has risen sharply over the past few years and by more than you would expect in terms of growth in the size of the elderly population.

Klink’s report says this is because doctors are paid per treatment and are too quick to advise expensive and complex operations without properly discussing the consequences and alternatives with patients.

The report looks at one classic example: operating on a prostate cancer tumour. The operation is expensive and risky and when the consequences (the risk of incontinence and impotence) and the alternatives (waiting, with the risk of a shorter life) are discussed in depth with patients, they often cancel.

The report sketches a situation in which a consultant takes a couple of minutes to advise an operation, ignoring the nuance, the patient’s wishes and scientific research in order to achieve the required levels of production.

Stop over-treating patients

In terms of prostate cancer, we are talking about treatment for which the alternatives have sufficient scientific basis: around half of hospital treatments are not backed up by solid scientific research basis which the doctor can use to base his or her advice on.

Klink and his team are advising a radical shake-up: healthcare providers should stop over-treating, improve the involvement of their patients and reorganise their institutions. This will lead to a fewer claims for health insurers who will in turn pay for quality.

Booz states this process will generate between €4bn and €8bn, without giving any further information. Direct questioning reveals that this estimate is based on extrapolating the cost of a number of treatments across the entire sector, but that these remain secret.

Trap

Klink is doing exactly the same thing as he accuses medical specialists. He is presenting a complicated operation: this proposal involves adapting systems, a change in behaviour, time and attention from doctors, managers, insurers and lawmakers, and even employers.

The savings are not transparent and are largely based on circumstantial evidence. Furthermore, he claims half the savings will be made on treatments for which there is no solid scientific basis available.

In addition, no comparison can be made with the numerous alternatives: is Klink’s cocktail better than Achmea’s evidence-driven approach? Can it be shown that Klink’s plan will have more effect than the current quality initiatives driven by the government and health insurers? And will halting, or indeed pressing on, with introducing market forces into healthcare not deliver as much?

And, finally, Booz has more of a financial interest in such far-reaching intervention that a cancer specialist earns from a simple operation.

Barend van Lieshout is management consultant at Rebel

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