There is widespread recognition that the trajectory of increase in expenditure on healthcare in developed economies is not sustainable, and this has manifested as an acute squeeze on NHS funding since the financial crisis of 2008. Policy-makers and the public have also recognised that surgical outcomes vary. Commissioners of services are under increasing pressure to ensure that expenditure is directed towards care that delivers a demonstrable benefit in health-related wellbeing to patients and, in choosing providers, commissioners seek to direct funding to those services that provide the highest quality of care ("value-based purchasing").
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