Nurses, the costs of healthcare, and the quest of value in healthcare


The proportion of national wealth directed to healthcare is evidence of the value given to it. Across the world, health spending is a substantial share of GDP, and as the wealth of a country increases, the percentage of healthcare wealth increases.

As per the WHO reports, health spendings as a percentage of GDP is approximately 7% in low-income countries, 6% in middle-income countries, and 10% in high-income countries.

Challenges faced by low-income countries involve utilizing the current workforce as efficiently as possible and expanding healthcare services to provide high-value care as quickly as possible. Nurses have been and still are a critical component in addressing care needs in an environment where the resources are limited.

In many low and middle-income countries, there are substantial shortages of nurses and physicians. The nurse-to-physician ratio varies in many countries and it has an indirect impact on the healthcare system. In India, there are about 1.5 nurses for each physician. Countries with low nurse-to-physician ratios may be missing opportunities to expand access and services faster and at a lower cost.

Issues related to the costing are different for higher-income countries, which have developed comprehensive healthcare systems. Most of them are able to provide good services for most of the population, and often have an insurance or financing system that provides broad coverage for the population shielding them from having to make hard decisions about which services to obtain. For these countries, maintaining access is critical, but so is containing costs.

Extensive research conducted across health systems in high and middle-income countries concludes that professional nurses bring training and expertise to the bedside that is critical to care, and when the nursing staff does not have the training, costs, deaths and other adverse events increase. Some other studies show that in hospitals with a lower percentage of professional nurses on the nursing staff, the costs of longer length of stay and higher rates of adverse events exceed the costs the hospital would spend to increase the proportion of staff that are professional nurses.

Looking beyond inpatient care, there has been an increased recognition in higher income countries that professional nurses can be more effectively used in outpatient care and in coordinating care across settings. These include history collection, physical assessment counseling and advising on how to effectively initiate & sustain prescribed treatments. This allows physicians to focus on assessment, diagnosis and prescribing care.

Outpatient settings find the additional cost of nurses is often offset by the increased volume of patients that can be accommodated and greater productivity of physicians. There has also been more extensive use of nurses as care coordinators and educators for patients with multiple chronic illnesses and patients about to be discharged from hospitals to reduce the likelihood of a hospital admission or readmission.

Finally, in both low and high-income countries, there has been increasing efforts to educate nurses for advanced practice in which nurses assume responsibility for assessment, diagnosis and prescription of treatments that they or others will implement.

Low, middle and high-income countries all strive to deliver high value health services at the lowest possible cost. Nurses are essential for the efficient expansion of high value care in low and middle income countries.

Ms Haritha Vijayan,
Chief Nursing Officer, Continental Hospitals, Hyderabad

Disclaimer: : The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.

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