Papel de la persona navegadora del paciente en el cáncer de pulmón / The Role of the Navigator Person for a Patient with Lung Cancer

Introducción: la medicina basada en el valor ha logrado mejorar la calidad de atención del paciente y/o la satisfacción de las personas, reduciendo costos y obteniendo mejores resultados. Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad. Sin embargo, existen pocas publicaciones sobre la estrategia de personas navegadoras para pacientes con cáncer de pulmón, que podrían ser una herramienta clave para brindar apoyo, asegurando que tengan acceso al conocimiento y los recursos necesarios a fin de completar la vía de atención clínica recomendada. Estado del arte: se trata de una intervención en salud cuyo objetivo principal es lograr vencer las barreras relacionadas con la atención (p. ej., logísticas, burocrático-administrativas, de comunicación y financieras) para poder mejorar la calidad y el acceso a la salud en el marco de la atención del cáncer. Estas personas cumplen un papel de guía para pacientes durante el proceso de diagnóstico y tratamiento activo. Su labor consiste en vincular al paciente con los proveedores clínicos, brindar un sistema de apoyo, asegurar un acompañamiento individualizado, garantizar que tengan acceso al conocimiento y a los recursos necesarios para completar el seguimiento y/o tratamiento adecuado. Discusión/Conclusión: indudablemente, es un elemento cada vez más reconocido en los programas de cáncer, centrado en el paciente y de alta calidad. Su implementación será de especial interés en la Unidad de Práctica Integrada para personas con cáncer de pulmón. (AU)

Introduction: Value-based medicine has succeeded in improving the quality of patient care and or patient satisfaction, reducing costs, and obtaining better outcomes. It rests on three fundamental pillars: evidence-based medicine, patient-centered care, and sustainability. However, there are few publications on the people navigator strategy for lung cancer patients, which could be a crucial tool for providing support, ensuring that they have access to the knowledge and resources needed to complete the recommended clinical care pathway. State of the art: It is a health intervention whose main objective is to overcome care-related barriers (e.g., logistical, bureaucratic-administrative, communication, and financial) to improve quality and access to health in the context of cancer care. These individuals play a guiding role for patients during the diagnostic and active treatment process. Their job is to link the patient with clinical providers, provide a support system, ensure individualized accompaniment, and guarantee that they get access to the knowledge and resources necessary to complete the appropriate follow-up and, or treatment. Discussion/Conclusion: Undoubtedly, patient navigators represent an increasingly recognized element of high-quality, patient-centered cancer programs. Its implementation will be of specific interest in the Integrated Practice Unit for people with lung cancer. (AU)

Practice of refined management of anti-tumor drugs based on value healthcare / 中华医院管理杂志

In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.

Study on value-based medical insurance access and pricing methods of multi-indication drugs / 中国药房

OBJECTIVE To discuss medical insurance access and pricing methods for multi-indication drugs. METHODS The access situation of multi-indication drugs in China’s medical insurance negotiation over the years was sorted out. Referring to the economic theory of value-based pricing and the relevant experience of other countries， five applicable pricing methods of 3 categories for multi-indication drug in China were summarized. Taking ceftazidime-avibactam（CAZ-AVI） as an example， cost- utility analyses were performed for different indications， and appropriate pricing methods were applied. RESULTS & CONCLUSIONS All multi-indication drugs in China adopted a single pricing method. The pricing methods that could be explored include product-based pricing， such as single pricing based on the lower-value indication or mixed/weighted single pricing； indication-based pricing， such as developing a new agreement for single pricing under different discounts and listing with different brands and pricing of the same medicine for different indications； and compensation for access restrictions. Each method has its advantages and limitations. The case of CAZ-AVI showed that it is necessary to estimate the value of each indication for multi- indication drugs， and comprehensively consider appropriate access conditions and pricing methods based on value. Although single pricing is simple to operate， it is different to reflect the value entirely. The indication-based pricing and compensation for access restrictions all depend on the information collection system and the cooperation of multiple departments. China is supposed to carry out the value-based pricing of multi-indication drugs and constantly explore reasonable access methods to improve overall social welfare.

US Value-Based Healthcare Policy and Its Role of Pharmacists: Contribution of Pharmacist in Accountable Care Organization (ACO) / 社会薬学

In the United States, the concepts of “Pay For Performance” and “Value-Based Health Care” were introduced, and it has been taken up as the way forward for the American health care systems. As one of the measures, an Accountable Care Organization (ACO) was included in the federal Affordable Care Act, and are being promoted for the purpose of balancing cost savings and good quality assurance in the healthcare field. In this manuscript, we provide an overview of the system of ACO, which is one of the value-based health care systems and was introduced with the aim of balancing cost savings and good quality assurance of medical care, and also focus on the role of pharmacists in ACO and summarize their roles they are executing and expected. Furthermore, we discuss on what we should learn from the United States in considering the ideal medical care systems in Japan.

Value-based health care in heart failure: Quality of life and cost analysis

Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

Patient-reported outcome measures and value-based medicine in paediatrics: a timely review

Healthcare delivery is moving towards a more personalised and patient-centric approach. There is now an appropriate emphasis on providing value in our healthcare system. Patient-reported outcome measures (PROMs) assess our patients' perceptions of the status of their health and quality of life, measured over a period of time. PROM is an integral component of a value-driven and value-based healthcare system and is key if we want to practise value-based medicine. In paediatrics and child health, PROMs, if implemented well with appropriate measurement tools that are regularly updated and validated in a self-learning healthcare ecosystem, will help to enhance personalised healthcare delivery and collectively improve the health of the community at large. This review covers the role of PROMs in paediatrics, as well as their role in value-based medicine.

Escore de Valor em Saúde (EVS): Uma proposta para mensuração de valor dentro de um sistema de saúde / Value-based Health Care Score (EVS): A proposal for measuring value within a health system

Um sistema de saúde baseado em valor deverá entregar os melhores desfechos possíveis ao paciente, desfechos que realmente importam para ele, ao menor custo possível. O conceito é relativamente fácil de entender, mas a métrica para a sua demonstração tem sido um grande desafio dos sistemas de saúde. O presente artigo demostra a criação de um Escore de Valor em Saúde (EVS) utilizando Análise de Decisão por Multicritério, o qual pode ser aplicado em qualquer sistema de saúde para avaliar profissionais, serviços de saúde e linhas de cuidado de pacientes com condições clínicas específicas.

A value-based healthcare system must deliver the best possible patient outcomes, outcomes that really matter to the patient, at the lowest possible cost. The concept is relatively easy to understand, but the metric to demonstrate it has been a major challenge for healthcare systems. This article demonstrates the creation of a Health-Based Health Care Score (EVS) using Multi-Criteria Decision Analysis which can be applied in any health system to evaluate professionals, healthcare providers and care pathways for patients with a specific disease.

Medical nutrition therapy in the context of value-based healthcare / 中华临床营养杂志

The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.

Process-based Management aimed at improving health care and financial results / Gestión basada en procesos visando a mejoría de los resultados asistenciales y financieros en Salud / Gestão baseada em processos visando à melhoria dos resultados assistenciais e financeiros em Saúde

ABSTRACT The limited resources allocated to the health area and the growing demands require leaders' qualified and committed performance in hospital management. In this perspective, the objective of this study is to reflect on the management practices that can be applied to hospital facilities to achieve better care and financial results. Among them, process-based management proposes an approach for continuous process improvement to achieve desired results; the method Lean Six Sigma allows identifying and eliminating waste in production processes; the continuous improvement model combines practical knowledge with the knowledge of how the system to be improved works, through observations and changes that allow its results measurement; and cost management and value-based healthcare provides for care mapping, from beginning to end, to assess what actually adds value to patients. The contributions of implementing these practices are recognized worldwide; using them, processes can be increased, improving efficiency, reducing waste, adding value to the business, increasing its revenue, and resulting in savings that can be passed on to the consumer, by improving quality.

RESUMEN Los recursos limitados destinados al área de Salud y las crecientes demandas exigen la actuación calificada y comprometida de líderes en la gestión hospitalaria. En esta perspectiva, el objetivo es reflexionar sobre las prácticas de gestión que se pueden aplicar a las instituciones hospitalarias para lograr mejores resultados asistenciales y económicos. Entre ellos, la gestión basada en procesos propone un enfoque de mejora continua de procesos para lograr los resultados deseados; el método Lean Six Sigma permite identificar y eliminar los desperdicios en los procesos productivos; el modelo de mejoría continua combina el conocimiento práctico al conocimiento del funcionamiento del sistema que se reta mejorar, a través de observaciones y cambios que permitan la medición de sus resultados; y la gestión de costes y de salud atención médica basada en el valor establece que la atención sea mapeada, desde el principio hasta el final del proceso, para evaluar lo que efectivamente es lo que agrega valor a los pacientes. Las contribuciones de implementación de esas prácticas son reconocidas a nivel mundial; con ellas se pueden incrementar los procesos, aumentando la eficiencia, reduciendo los desperdicios, agregando valor al negocio, aumentando sus ingresos y generando ahorros que pueden transferirse al consumidor, al mejorar la calidad.

RESUMO Os recursos limitados destinados à área da Saúde e as demandas crescentes requerem a atuação qualificada e compromissada dos líderes na gestão hospitalar. Nesta perspectiva, objetiva-se refletir sobre as práticas de gestão passíveis de serem aplicadas às instituições hospitalares visando o alcance de melhores resultados assistenciais e financeiros. Dentre elas, a gestão baseada em processos propõe uma abordagem para melhoria contínua dos processos a fim de alcançar os resultados desejados; o método Lean Six Sigma permite identificar e eliminar desperdícios nos processos produtivos; o modelo de melhoria contínua alia o conhecimento prático ao conhecimento do funcionamento do sistema a ser melhorado, por meio de observações e mudanças que permitam a mensuração de seus resultados; e a gestão de custos e a Saúde baseada em valor preveem que o cuidado seja mapeado, do início ao fim do processo, para avaliar o que, de fato, agrega valor aos pacientes. As contribuições da implementação dessas práticas são reconhecidas mundialmente; utilizando-as, os processos podem ser incrementados, aumentando a eficiência, reduzindo os desperdícios, agregando valor ao negócio, aumentando a sua receita e resultando em economias que podem ser repassadas ao consumidor, pela melhoria da qualidade.

Indicadores de calidad en la atención de salud en cirugía oncológica de cabeza y cuello / Quality indicators in health care in head and neck cancer surgery

Resumen La mayoría de los servicios de salud han experimentado un aumento de los costos asociados a la atención de salud lo que ha llevado a adoptar medidas para optimizar la costo-efectividad de los servicios otorgados. Desde esa perspectiva surge la atención de salud basada en el valor. El concepto de "calidad en la atención de salud" se ha definido como el grado en el cual los servicios de salud aumentan la posibilidad de generar ciertos desenlaces en salud a los que se aspira. Los indicadores de calidad de clasifican en indicadores de estructura, de proceso, y de desenlace. Los indicadores de estructura se refieren a las características del sistema de salud o de la institución hospitalaria. Los indicadores de proceso se refieren a los que el proveedor de servicios de salud realiza para el proceso de atención en salud, mientras que los indicadores de desenlace se refieren a los resultados del proceso en el paciente. El objetivo de la presente revisión es proveer un marco conceptual para dar un contexto al concepto de indicadores de calidad en salud y el rol que estos juegan en cirugía oncológica de cabeza y cuello. Se debe aspirar a lograr un mayor cumplimiento de los indicadores de calidad en cirugía oncológica de cabeza y cuello, especialmente en instituciones terciarias de referencia. Aplicar indicadores de calidad en el manejo oncológico en cabeza y cuello permitiría mejorar tanto la percepción y satisfacción del usuario, como también mejorar resultados oncológicos en estos pacientes.

Abstract Most health services have experienced an increase in the costs associated with health care, which has led to the adoption of measures to optimize the cost-effectiveness of the services provided. From this perspective, the concept of value-based health care emerged. The concept of "quality in health care" has been defined as the degree to which health services increase the possibility of generating certain desired health outcomes. Quality indicators are classified into structure, process, and outcome indicators. The structure indicators refer to the characteristics of the health system or the hospital institution. Process indicators refer to those that the health service provider performs for the health care process, while outcome indicators refer to the results of the process in the patient. The objective of this review is to provide a conceptual framework to give a context to the concept of health quality indicators and the role they play in head and neck surgical oncology. The system should aspire to achieve greater compliance with quality indicators in head and neck cancer surgery, especially in referral tertiary institutions. Applying quality indicators in head and neck cancer management would improve both user perception and satisfaction, as well as improve oncological results in these patients.

Progress and implications of value-based medical payment in the United States / 中华医院管理杂志

Value-based medicine is a healthcare delivery mode with the objective of obtaining better medical quality and health outcomes at a certain cost. The authors introduced the concept of value-based medicine, reviewed its background in the United States, described the transformation of payments from fee-for-service to value-based modes of the Centers for Medicare and Medicaid Services in the United States, and analyzed current challenges of value-based payment. Then the authors discussed the implications for China′s medical service providers to carry out value-based medical practice, in order to provide reference for China′s medical workers to participate in the construction of high-value medical system.

Effect Evaluation of National Drug Centralized Volume-based Procurement in a Public Hospital from the Per- spective of Value-based Healthcare / 中国药房

OBJECTIVE：To evaluate the implementation of national drug centralized volume-based procurement （called “VBP”for short）in a public hospital，so as to provide reference for promoting VBP policy guided by value-based healthcare. METHODS：A total of 6 varieties and 12 specifications of antibiotics included in VBP in a public hospital in Chongqing were analyzed. The drug use data of the hospital one year before the implementation of VBP（i.e. April 20，2019- April 19，2020）and one year after the implementation（i.e. April 20，2020-April 19，2021）were collected and analyzed in respects of price change， generic drug substitution rate，average daily cost（DDDc），actual cost savings and other indicators. The problems and suggestions were put forward，and the effects of VBP policy implementation whether reflects the core connotation of value-based healthcare were evaluated. RESULTS：After the implementation of VBP，drug prices fell by an average of 63.44％，the average price drop of original drugs was 27.38％ ，and substitution rate of generic drugs was 25.59％ . DDDc of selected antibiotics in the hospital decreased in varying degrees，of which the decline of four drugs was 10％-40％，and that of Moxifloxacin hydrochloride tablets was 80.14％. Compared with bef VBP，6 kinds of antibiotics saved about 521 300 yuan，of which the imported Moxifloxacin hydrochloride tablets and Moxifloxacin hydrochloride sodium chloride injection saved 495 300 yuan（accounting for 94.97％ of the total cost savings of antibiotics）. CONCLUSIONS：The value of VBP based on the perspective of value-based healthcare is mainly reflected in the dual channel management mechanism of drugs，which improves the availability of drugs，effectively controls the unreasonable growth of medical expenses，reduces the expenditure of medical insurance fund，and helps to further reduce the drug burden of patients. At present，the implementation of VBP still faces difficulties，including the need for drug prices to return to a reasonable range，the need for foreign enterprises to change strategies to seek a breakthrough，and different therapeutic efficacy due to the difference in quality between the selected generic drugs and the original drugs. Therefore，the author believes that the pharmaceutical market structure should be transformed positively，value-based healthcare should help the regulation of medical insurance，and the consistency evaluation system should be optimized，so as to further improve the health level of patients.

International Experience and Enlightenment of Medical Insurance Reimbursement for Multi-indication Drugs Based on Value-based Pricing / 中国药房

OBJECTIVE：To provide reference for improving medical insurance reimbursement for multi-indication drugs based on value-based pricing in China. METHODS：The theory and practice of value-based pricing for multi-indication drugs were sorted out，and the value standards and medical insurance reimbursement strategies based on value-based pricing in France，Germany，UK，Italy and Sweden were analyzed，so as to provide the suggestions for medical insurance reimbursement of multi-indication drugs in China. RESULTS & CONCLUSIONS：The realization of value-based pricing first needed to develop a value framework to define，measure and integrate value，and then established a model to convert the total value into price. The overall idea of value-based pricing for multi-indication drugs was consistent，but there were differences in the value standard. In the UK and Sweden， quality-adjusted life years （QALYs） and incremental cost-effectiveness ratios （ICERs） measured by pharmacoeconomicsare used as the value standard. France，Germany and Italy were more focused on the therapeutic value and clinical benefit improvement. As for medical insurance reimbursement strategies，France adopted single weighting method based on expected volume. Germany adopted combination weighting method based on value and volume. UK introduced the Patient Access Schemes and Italy introduced the Managed Entry reements，both based on the nominal reimbursement standard. Sweden adopted independent reimbursement for different indications by different brand names. It is suggested that China can explore the value-based pricing strategies of multi-indication drugs on the basis of the above international experiences，reference and use these variety of medical insurance reimbursement strategies comprehensively. Simultaneously，the information collection mechanism of patients and drug use should be improved to provide data support for the implementation of China’s value-based pricing and reimbursement strategies for multi-indication drugs.

Inpatient Care Expenditure of Terminally Ill Patients in the Geriatric Ward of Peking Union Medical College Hospital / 中国医学科学院学报

Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.

Profile and inspirations of hospital value-based purchasing of MS-DRG in the United States / 中华医院管理杂志

Pay-for-performance(P4P) is the third stage of payment evolution in the United States. As of 2010, the Centers for Medicare and Medicaid Services launched a series of P4P programs, including hospital value-based purchasing(HVBP) program. This paper introduced the background and eligibility of HVBP in the United States, focusing on the contents and calculation methods of HVBP as references for the reform of payment methods in China.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais / Remodeling hospital care - an account of experiences in the Federal District of Brazil

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.

Abstract Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.

Applications of health technology assessment in value-based management of total health expenditure / 中华医院管理杂志

Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′ participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.

Applications of health technology assessment in value-based management of total health expenditure / 中华医院管理杂志

Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.

Atención en salud basada en el valor: retos y oportunidades / Value-based health care: challenges and opportunities / Assistência médica baseada em valor: desafios e oportunidades

La atención en Salud Basada en el Valor es un modelo de atención re-ciente, innovador, dirigido a garantizar mejores resultados en salud para la población atendida, paralelo a un uso óptimo de los recursos. Para su implementación, dicho modelo propone una serie de principios, los cua-les son analizados dentro del presente documento. Para esto, se tiene en cuenta no sólo sus características fundamentales, sino también, su facti-bilidad, posibles barreras y oportunidades. Los principios revisados son: unidades integradas de atención, medición de resultados en salud y cos-tos, plataformas tecnológicas, modelos de pago centrados en la atención, sistemas integrados de atención y expansión geográfica. Adicionalmente, se incluyen la atención centrado en el paciente y el trabajo en equipo co-mo componentes fundamentales de este modelo también

Value-based Health Care is a recent, innovative delivering healthcare model which has emerged as a cost-effective alter-native to provide superior health outcomes for patients while decreasing inefficiencies in the system. For its successful im-plementation this model provides a set of principles which are revised in the present article, providing insights on their feasibility, challenges and opportunities. The principles revised here are: Integrated Practice Units, Health Outcomes and Cost Measurement, Value-based Payments, enabling health systems platforms, and efficient allocation of resources. Along with the-se, a person-centered approach and stakeholders' participation and engagement have been also revised as key components of the model.

A assistência médica baseada em valor é um modelo de assis-tência inovador que visa garantir melhores resultados de saúde para a população atendida e o uso ideal dos recursos. Para sua implementação, propõe-se uma série de princípios anali-sados neste documento, uma análise na qual são levadas em consideração as características fundamentais, viabilidade, pos-síveis barreiras e oportunidades que esse modelo pode gerar. Os princípios revisados são: unidades de atendimento integra-das, mensuração de resultados de saúde e custo, plataformas tecnológicas, modelos de pagamento focados na geração de valor, sistemas / redes de atendimento integrados e expansão geográfica. Além disso, o atendimento centrado no paciente e o trabalho em equipe são incluídos como componentes funda-mentais deste modelo.