Clinical-outcome-based demand management in health services.

UNLABELLED: THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. TECHNIQUE FOR MANAGING DEMAND: The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. CONCLUSION: The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.