Cost-saving strategies for sustainable surgical care: a scoping review of efficiency models and potential approaches for low-income and middle-income countries.

INTRODUCTION

While philanthropy, multilateral support and innovative internal funding approaches remain important to address surgical healthcare needs, there is increasing demand for efficiency models that maximise the impact of available resources. Cost-saving strategies are attractive to governments. We sought to answer the scoping review question: 'What are documented and transferable system-level cost-saving strategies in the provision of surgical healthcare services applicable in limited-resource settings?'

METHODS

The scoping review was guided by the Arksey and O'Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines; 642 studies were screened from PubMed, EMBASE, Global Index Medicus, Africa Journals Online and Google Scholar (2015-2024), without language or article type restrictions. Following title, abstract and full-text screening by 2 independent reviewers, we identified 63 records that met inclusion criteria: documented cost-saving strategies in surgical systems from community to national levels. Strategies were extracted into a theoretical framework adapted from the Procter and Gamble's cost optimisation model and the Triple Aim Framework using Jabareen's eight-step method.

RESULTS

Most literature on cost savings for surgical healthcare was from high-income countries (81%), at national levels (48%), and focused on orthopaedic/cardiothoracic/vascular surgery. Most (25%) were retrospective observational studies or economic modelling (21%). We synthesised 125 distinct cost-saving strategies into 32 transferable strategies across five thematic areas, prioritised using a sustainability and scalability lens-preventative healthcare management (9%), surgical healthcare guidelines and pathways (31%), payment model transformation (19%), lean principles (25%) and technology adoption (16%). Strategies focused on governance, standardisation and process redesign were more likely to be sustainable and scalable with minimal resources, whereas interventions requiring coordinated delivery models or advanced digital infrastructure were more scale-dependent

CONCLUSIONS

We identified an integrated portfolio of contextualisable surgical cost-saving strategies that eliminate system waste, improve efficiency and result in savings. Policymakers and health system stakeholders in low-income and middle-income countries can use this structured evidence to prioritise, implement and scale cost-saving strategies.