• Sophie Coronini-Cronberg, Honor Bixby, Anthony A Laverty, Robert M Wachter, and Christopher Millett.
• Sophie Coronini-Cronberg (s.coronini-cronberg@imperial.ac.uk) is an honorary research fellow in the Department of Primary Care and Public Health, Imperial College London, and a consultant in public health in the Centre Medical Directorate with Bupa, both in the United Kingdom.
• Health Aff (Millwood). 2015 Mar 1; 34 (3): 381-9.

AbstractThe pressure to contain health expenditures is unprecedented. In England a flattening of the health budget but increasing demand led the National Health Service (NHS) to seek reductions in health expenditures of 17 percent over four years. The spending cuts were to be achieved through improvements in service quality and efficiency, including reducing the use of ineffective, overused, or inappropriate procedures. However, the NHS left it to the local commissioning (or funding) organizations, known as primary care trusts, to determine what steps to take to reduce spending. To assess whether the initiative had an impact, we examined six low-value procedures: spinal surgery for lower back pain, myringotomy to relieve eardrum pressure, inguinal hernia repair, cataract removal, primary hip replacement, and hysterectomy for heavy menstrual bleeding. We found significant reductions in three of the six procedures-cataract removal, hysterectomy, and myringotomy-in the program's first year, compared to prior years' trends. However, changes in the rates of all examined procedures varied widely across commissioning organizations. Our findings highlight some of the challenges of making major budget cuts in health care. Reducing ineffective spending remains a significant opportunity for the US health care system, and the English experience may hold valuable lessons.Project HOPE—The People-to-People Health Foundation, Inc.

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