The Economic Burden of Unsafe Care: A Systematic Review With Narrative Synthesis on the Economic Cost of Unsafe Care in Hospitals Worldwide

Unsafe care places a substantial economic and clinical burden on health care systems worldwide, yet its cost implications remain insufficiently understood. This review synthesizes recent literature to clarify the magnitude and nature of the economic burden associated with unsafe care in hospital settings. A comprehensive search of Medline, EMBASE, and CINAHL, complemented by chain referencing, identified studies published since 2019. Of the 6364 identified articles, 25 met the inclusion criteria. Extracted data included study characteristics, methodological approaches, matching or correction variables, and reported costs and indicators of unsafe care, with all cost estimates converted to 2019 US dollars. The findings show that unsafe care in hospitals leads to considerable excess costs across multiple economic perspectives. For hospitals, the additional cost per unsafe event reached as high as $140,000. From the public payer’s perspective, unsafe care accounted for up to nearly 3% of national health care spending, exceeding 0.2% of gross domestic product in some cases. From a societal perspective, unsafe care resulted in prolonged hospital stays, productivity losses, and broader economic impacts, amounting to an equivalent of up to 8% of health care expenditure. Unsafe care was consistently associated with poorer patient outcomes, including longer hospital stays, more frequent readmissions, and higher mortality. Despite heterogeneity in methods, the included studies collectively indicate that unsafe care imposes a significant economic burden while undermining patient health.