Health policies and data

The Economics of Patient Safety



Patient safety is a critical policy issue and remains an important challenge to all OECD health systems. Many adverse events leading to harm could have been prevented if appropriate safety protocols and clinical guidelines were followed.

Reducing the occurrence of adverse event and harm would reduce waste, release resources and make the case for more efficient and effective health systems in the OECD.

The OECD has produced two reports on the Economics of Patient Safety, informing the Global Ministerial Summits on Patient Safety in 2017 and 2018:


  • Patient harm is estimated to be the 14th leading cause of global disease burden, comparable to TB, malaria and some types of cancer
  • On average, 1 in 10 hospitalisations results in safety failure or adverse event
  • As many as 4 out of 10 patients experience safety issues in primary and ambulatory care settings
  • Up to 15% of hospital expenditure and activity in the OECD countries can be attributed to treating patient safety failures
  • Many adverse events are preventable. The costs of prevention are dwarfed by the costs of failure, leading to waste in health systems across the OECD

The type of adverse events may vary by care setting



Adapted from Kingston-Riechers J. et al (2010), Etchells et al (2012), Levinson (2014).
Source: The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level, p.10. OECD Health Working Paper No. 96. March 2017.

KEY FINDINGS on reducing harm effectively and efficiently

The causes of patient harm are complex and dynamic - reflecting the increasing complexity of health care - and reside in the structures, processes and delivery points across all levels of a healthcare system. A range of interventions, programs and initiatives exists to tackle harm and improve patient safety.

  • To shed light on how countries might prioritise action to improve safety, a survey was distributed to a panel of expert policy makers and academics. The experts were asked to assess and compare the cost and impact of a selection of interventions across three levels; system-level, organisational/institution-level and clinical level.

  • Survey results suggest that a national approach to reducing patient harm should adopt a system-perspective. The relative impact and costs rating favour clinical-level interventions targeting the most burdensome adverse events: VTE prophylaxis, protocols to minimise central-line catheter insertion, pressure injuries, urinary catheter associated infections, procedural and surgical check lists. These highest rated interventions are backed by sound evidence.

  • General concordance was identified between academic and policy experts’ responses. Nonetheless, there were some notable differences between the two panels. The policy panel reported more positive ratios, and favoured interventions targeting clinical level. The academic panel was less optimistic about the relative impact of the interventions, in addition to less variation between the system, organisational and clinical level.

  • Patient safety strategies are rarely implemented in isolation. When selecting interventions for ‘best buys’, prioritisation elevated the importance of system- and organisational level interventions. For OECD countries system- and organisational levels were most selected interventions (52% and 37% respectively); professional education and training, clinical governance systems, safety standards, person, and patient engagement strategies. Developing a culture conducive to safety was seen as critical.

  • While the pattern of patient harm was different in low-to-middle income countries, the strategies of how to improve patient safety were quite similar. Expert panels favoured system- and organisational level interventions (45% and 39% respectively) and emphasised fundamentals such as professional education, safety standards and interventions targeting healthcare-associated infections and nationally specified patient safety priority themes.

Source: The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level. OECD Health Working Paper No. 96. March 2017.



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