As governments in developing nations are obligated to provide universal health coverage — with the delivery of healthcare made either through the public sector, private sector, or in most cases, through public-private partnership — the healthcare industry has undergone a transformative shift in recent years, moving from a traditional fee-for-service model to one centred around value-based care.
The focus is now on delivering high-quality care that produces favourable patient outcomes while controlling costs by enhancing efficiency. This approach encourages healthcare providers to prioritise preventive care, patient education, and coordination of services to optimise health outcomes.
Healthcare delivery models
Universal health coverage is characterised by four elements — availability, accessibility, affordability and acceptability (quality). In terms of 'availability', the World Health Organization (WHO) specifies 3.5 beds and one doctor per 1,000 population, while accessibility means having a healthcare infrastructure located within a reasonable distance and time zone. Quality means that healthcare services are based on standard treatment guidelines and patient safety is an integral part of it.
Quality is supposed to be regulated by enforcing a minimum set of conditions related to healthcare infrastructure including the availability of requisite manpower. The payers specify more stringent conditions like mandating healthcare providers to seek accreditation from authorised agencies. This ensures quality and patient safety and, at same time, safeguards liability on the part of payers.
Value-based payment models are based on evaluating a set of clinical indicators like hospital-acquired infections, adverse events, surgical complications, average length of stay along with patient satisfaction score. Payers provide reimbursement to hospitals based on these indicators, which encourages hospitals to adhere to quality practices. Value-based care accordingly focuses on improving patient outcomes while controlling costs. It simultaneously promotes preventive care, patient engagement, and coordination among healthcare providers to achieve better health results.Â
By fostering collaboration and innovation, value-based care aims to enhance overall healthcare quality, efficiency, and patient satisfaction while addressing the broader goals of healthcare sustainability and equity.
Shifting the focus from volume to quality
Value in healthcare is the quality of care, which is measured through improvement in the patient’s health outcomes for the cost of achieving that improvement. It aims to improve clinical experience, patient experience and population health and reduces the cost of care. It enables the healthcare system to create more value for patients. Value-based care is developed by implementing a continuum of care by integrating various aspects of care to leverage the best treatment options for patients, enhancing patient experience by providing treatment in a transparent and cost-effective manner.
It is important to note that the most common factors causing medical errors are communication failures among healthcare professionals and with patients, absence of documented systems and processes, human factors arising out of fatigue and insufficient training and medication errors by way of mistakes in; prescription, dispensing and administering. Quality and patient safety should therefore be uppermost in mind for healthcare providers before going for the volume, as it enables achieving patient-centric care and in the long run even reducing the operational cost through efficiently utilising resources, following standard treatment guidelines, avoiding complications and achieving best patient satisfaction.Â
Cost vs quality in the context of healthcare has been debated for a long time. Quality in healthcare may incur ‘costs’ but the absence of quality may ‘cost’ life. There has been marked improvement in health outcomes due to the advent of technology, the availability of super specialists and advances in the science of medicine. The shift from volume-based to value-based healthcare represents a paradigmatic change in how healthcare is delivered and reimbursed. By focusing on quality, outcomes, and patient-centred care, ‘Value-Based Care’ aims to create a healthcare system that is more efficient, effective, and equitable.
Dr Girdhar Gyani is the Director General of the Association of Healthcare Providers, New Delhi, India. He will be speaking about 'Value-based healthcare: Shifting focus from volume to quality and outcomes'Â at the Hospital Management track at Asia Health on July 10 at 13:30.Â
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