Table. Sources of Waste and Opportunities for Reform .

Berwick and Hackbarth’s Definition 2	Domain Components 3	Current Events	Advices for Reform
Failures of care delivery ‘Poor execution or lack of widespread adoption of known best care processes.’	Patient safety Preventive care Practice- and delivery system-based inefficiency	Cost-effectiveness of public health made clear Postponing elective high value care E-health widely adopted Scalability of acute care functions Acute care out crowds other delivery functions	Strengthen international governance and the monitoring and detecting functions of diseases Prioritizing high value care Make current e-health levels the new normal Rigorous real world effectiveness evaluations Create spare capacities necessary supplies and (human) capital Redirecting the delivery system towards separate workstreams
Failures of care Coordination ‘Patients fall through the slats in fragmented care.’	Reduce unnecessary hospitalizations Coordination super utilizers/complex patients Seamless transitions of care Integrated data systems	Coordination of acute care centralized Higher COVID-19 mortality Quick transmissions between care levers Timely available data of key importance	Align governance with specific subsystems Design structures around co-morbidity as the new normal Create central integrated data system Create central integrated data system
Overtreatment or low-value care ‘Subjecting patients to care that, according to sound science and the patient’s own preferences, cannot possibly help them.’	Low-value care Overdiagnosis Overprescribing Overuse in end of life care	Low-value care comes to a hold Large scale data show treatment differentials as a result of the COVID shock	Top-down approach to prevent a V-shape recurrence of low value care Measurement of watchful waiting situation that has arisen Stricter purchasing according to type of care Lower reimbursement elective/chronic care
Administrative complexity ‘Government, accreditation agencies, payers, and others create inefficient or misguided rules.’	Inefficient or misguided rules Billing and coding	Immediate needs prevail regulations	Put a (pseudo)price on administrative complexities by payers
Pricing failures ‘Prices migrate far from those expected in well-functioning markets.’	Absence of effective transparency and competitive markets	Inherent cross-subsidies towards acute care become visible	Ending cross subsidies
Fraud and abuse ‘The waste that comes as fraudsters issue fake bills and run scams.’	Costs of fraud and abuse	The need for essential goods (ventilators, masks) leads to extreme pricing	Coordinate purchasing of vital goods on the global market

Abbreviation: COVID-19, coronavirus disease 2019.