[Cost-effectiveness of quality improvement measures in health care].

GOAL: To discuss the costs and cost-effectiveness of quality improvement programs in health care. COST SAVINGS THROUGH QUALITY IMPROVEMENT: A quality improvement program saves costs if its investment costs are lower than savings from avoiding medical services. Cost savings are most likely realized if a) an overuse or misuse problem is targeted, b) many patients are affected, and c) striving for optimal quality is avoided. The overall prospect of cost savings is small, however. COST-EFFECTIVENESS OF QUALITY IMPROVEMENT PROGRAMS: From a societal perspective a quality improvement is economically attractive if an improvement in health status justifies its expenses including induced costs--even if total costs increase. In the USA a cost-effectiveness ratio of $50,000 per quality-adjusted life year is often applied as a maximum acceptable threshold value. From an institutional perspective the impact of a quality program on revenues is also important. An improvement of the image may increase the number of cases and thus revenues. For services reimbursed on a per-diem basis revenues behave according to changes in the length of stay. From an institutional perspective it is therefore reasonable to consider economic criteria when targeting problem areas.