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You getting value for your health expenditure?

Traditionally, healthcare expenditure has been based on a fee-for-service model. That means when you access healthcare, you almost blindly pay for whatever gets done, regardless of whether all you got billed for was beneficial to you. The alternate model is referred to as value-based care. This aligns healthcare payments to outcomes that are of benefit to patients. Thus payments or reimbursements to healthcare providers and doctors isn’t based on clinical volumes, but on measurable ‘value’ of care and patient benefits.

The business of medicine is tuned to sustainability and profitability. Hence the volume of work matters, inevitably leading to repeated consults, multiple tests, expensive interventions, multiple prescriptions, and inappropriate admissions. All such actions generate huge revenues for healthcare providers. But the real value to individual patients is questionable, especially when faced with a multiplicity of billable interventions that do not correlate with desired health outcomes.

If you are a lay person, you might find it hard to determine if you are getting value for your healthcare expenditure. But you only need to maintain a certain level of alertness during your clinical encounters, and be ready to question everything. A few examples are in order. No one really benefits from repeated consults and unending follow-ups for stable conditions. There’s nothing like routine tests, any tests recommended must add value to your diagnosis or treatment. If you find yourself with a bagful of prescribed meds, most or all are useless. No one ever needs to be admitted into a hospital for a mundane reason, doesn’t confer any benefits. The list goes on and on. If anything doesn’t appear valuable to you, don’t accept to pay for it.

The other side of value-based care rests on healthcare providers. The emphasis must be on quality rather than quantity. Health service providers must build teams whose primary goal is to provide the best possible care, with the lowest costs. This requires adherence to evidence-based medicine, and quick avoidance of the temptation to recommend unnecessary interventions. Technological innovations already allow for adoption of many strategies to balance cost and good outcomes. Compensation models and incentives to doctors and other service providers must increasingly be linked to patient outcomes, rather than the clinical volumes accrued.

If you are getting value for your healthcare, you will spend less and achieve even better health. Your doctor will focus more on getting you better. You should expect fewer doctor’s visits, fewer medical tests and procedures, and less prescriptions. Your healthcare provider will benefit too by becoming more efficient, and achieve even higher patient satisfaction ratings. Further downstream, there will be benefits with overall costs of health insurance and improved accessibility to healthcare by those in the low socio-economic group.

The next time you are in a clinical encounter, think value. Hopefully your doctor will think value too, and not volume.


Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.amurage@mygyno.co.ke

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