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When I use a word . . . . Examining the efficiency paradox

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2856 (Published 19 November 2021) Cite this as: BMJ 2021;375:n2856
  1. Jeffrey K Aronson,
  2. clinical pharmacologist
  1. Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
  1. jeffrey.aronson{at}phc.ox.ac.uk

Healthcare involves tackling patients’ problems using many different types of resources, both human and technological, and the spaces in which they operate. Variability in, on the one hand, human abilities, the performance of technologies, and the available facilities, and, on the other, the problems that patients present with distorts our ability to maximize the efficiency with which we use healthcare resources while minimizing the time a patient spends in the healthcare system and the inconvenience involved. Variability in demand and lack of resources also contribute. The efficiency paradox is that in healthcare efficient use of resources tends to increase the time a patient spends in the system and the inconvenience involved. But the efficiency paradox is not a paradox at all. It is a consequence of identifiable problems in the way that healthcare is delivered, albeit without identifiable solutions that can be simply implemented.

In a previous article I mentioned the efficiency paradox, or antinomy, in healthcare.1 Briefly, it arises from the mistaken belief that maximizing the efficient use of resources in a healthcare system necessarily improves the efficiency with which the patient progresses through the system. I suggested that, given the current problems in the NHS, it is hard to see how to resolve the problem of maximizing resource efficiency while minimizing the time that a patient spends experiencing care and the attendant inconvenience. Here I explain why.

Any process with measurable outputs that take time to achieve depends on the resources available to carry the process through. In …

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