Health cost and value

Healthcare is one of the most challenging sectors facing global economies. The structure of current health systems only recognizes a reduction in expenditures, sources of income and volume of care, essentially without guidance for the assessment of clinical outcomes.
When it comes to defining “value” in health, from the system’s point of view, the equation “value = results/cost” fails to take into account some critical aspects of society’s interests, which is why a broader and more holistic view is needed.
Cost, the denominator of the equation, refers to the total costs of the full course of care for a user’s medical condition, not the cost of individual services. To reduce costs, often the best approach is to spend more on some services to reduce the need for others.
Value in healthcare, defined as the health outcomes achieved for each euro invested, is reflected in the clinical benefits achieved by the investment.
Value, as a health outcome combined with costs, should define the framework for improving performance in the health system. Focusing on the value in health will lead to a healthier, more productive and resilient society.
Good results achieved efficiently are the goal and not false “savings” resulting from cost shifting and service restriction. The only way to truly contain healthcare costs is to improve outcomes: In a value-based system, it is less expensive to achieve and maintain good health than to deal with ill health.
By placing the person at the center of health services, the self-management of health is promoted, as well as the provision of health services on the basis of cost-effectiveness in the community and closer to the people.
These concepts are profoundly changing the paradigm of how health care is delivered to people: a team-oriented, networked approach to managing patient care, with responsible sharing of patient data, so that care is coordinated and informed.
It is necessary to reorganize the delivery of care around specific diseases. The system of sequential and uncoordinated visits to various providers, departments and disciplines works against courage. Instead, there is a need to transition to integrated practice modules that include all capabilities and services needed throughout the full course of each medical condition, including co-existing conditions and complications; In this way, continuity of care is ensured through the coordination of services along the value chain.
What about creating value in oral health?
We need value-based models in dentistry that reward quality of outcomes rather than quantity of services.
This approach would encourage prevention and personalization in care. The benefits of delivering value-based care are clear: reduced waste, lower costs, and most importantly, improved oral health for patients. Reaching this level, however, requires innovation, perseverance, and redesign of the oral health system.
Let us see that, for more than two centuries, dentistry and oral hygiene have been (and still are) practiced and made available in a fee-for-service, pay-per-action manner, that is, the system encourages more and more complex procedures, does not prevent disease and costs higher, leads to unbalanced financial incentives. This fragmented healthcare system isolates oral health care providers from other healthcare professionals and is not designed to achieve the best outcomes for patients.
New payment methodologies that focus on appropriate, person-centred care for all patients have emerged through the dissemination of best practices with the aim of reducing ineffective care and inappropriate use of services.
Value-based projects in oral health are more effective the more they focus on prevention, characterizing minimally invasive procedures, taking into account risk levels to ensure equitable distribution of resources, including incorporation of clinical data, supply chain and a variety of person-centered models.

Value-based oral health care is designed to align the delivery system, person, provider, and community to achieve better health outcomes at lower costs.
A measure of courage would also allow for a reform of the repayment system for rewarding Valor by providing lump sum payments covering the entire cycle of care or, for chronic cases, covering periods of one year or more. Matching reimbursement and value in this way rewards providers for their efficiency in delivering good outcomes, while creating liability for suboptimal care.
We need a better way to pay for health care that rewards providers for delivering greater value to patients: better health outcomes at lower cost.

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