Intended for healthcare professionals


Eliminating waste in healthcare spending

BMJ 2017; 356 doi: (Published 07 February 2017) Cite this as: BMJ 2017;356:j570
  1. Kalipso Chalkidou, director1,
  2. John Appleby, director of research2
  1. 1Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, UK
  2. 2Nuffield Trust, London, UK
  1. Correspondence to: K Chalkidou k.chalkidou{at}

There is no silver bullet—just incremental change based on good data

Health systems in all countries—no matter how they are organised, funded, and regulated—should strive to maximise benefits to patients for every pound, dollar, or euro they spend. The cost of not doing so can be measured in money terms—but, more importantly, in death, pain, and disability that could have been averted. But, as the Organisation for Economic Cooperation and Development (OECD) pointed out recently, a considerable chunk of the world’s health spending is probably wasted, and the key determinants of the level of wasteful spending are the organisation, funding, and regulation of countries’ healthcare systems.

Characterising waste

The organisation suggests that about one fifth of healthcare spending across OECD countries is wasted. This is equivalent to $1.2tr (£950bn; €1.1tr) and equal to five times the annual spending on the UK NHS.1 This figure is consistent with a 2010 analysis by the World Health Organization which concluded that 20-40% of healthcare spending globally is …

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