Name: Bellarmine T.

Millena
Level: II
Block: A
Topic: MEANING & SERVICE VALUE OF MEDICAL CARE;
ALLOCATION OF HEALTH RESOURCES; ISSUES INVOLVING
ACCESS TO CARE

MEANING AND SERVICE VALUE OF MEDICAL CARE

Michael E. Porter & Elizabeth O. Teisberg

- proposed a single unifying goal for health care: to deliver value for the patient.
- VALUE: defined as the outcomes that matter to patients and the costs to achieve
those outcomes.
- to achieve value for patients; health care delivery needed to be organized around
the medical conditions’ patients have, accurately measure the outcomes that
matter to patients, and measure the cost to achieve them.
VALUE-BASED HEALTHCARE

- Based on their work entitled: Redefining Health Care Creating Value-

Based Competition on Results (2006) by Harvard University Professor
Michael E. Porter and was co-authored by Elizabeth Teisberg
- Widely touted as critical to improving the health outcomes of patients
worldwide and controlling runaway health care costs
- Main Concept/Idea: This focus on prevention lowers the need for
expensive medical tests, ineffective medications and unnecessary
procedures.
How does value-based care reduce costs?

- providers such as hospitals and doctors are paid based on patient

outcomes, rather than the current “fee-for-service” model. In other words,
the provider is rewarded for helping patients become healthier.
- With the concept of value-based care, doctors and hospitals get paid based
on outcomes, not on numbers of procedures done, patients seen, or how
much they are charged. Rather than charging a patient for each individual
test or service, payments are bundled
- Electronic medical records for each patient eliminate repetitive and
unnecessary tests and procedures.
 - Teams of doctors and healthcare professionals communicate with one
another through the help of care coordinators to treat patients with more
efficiency and less wasted time and effort. Patients move through this
integrated system more quickly.
- The ideal result is fewer readmissions and less frequent hospitalizations
and trips to the emergency room. Value-based care is a long-term goal. It’s
a proactive concept to keep healthcare costs down, produce better
healthcare outcomes and most importantly, improve your overall health
and wellbeing.
Benefits of Value-Based Healthcare
1. Patients spend less money to achieve better health.
2. Providers achieve efficiencies and greater patient satisfaction.
3. Payers control costs and reduce risk.
4. Suppliers align prices with patient outcomes.
5. Society becomes healthier while reducing overall healthcare spending.

ALLOCATION OF RESOURCES
Health Care Resources: Defined as all materials, personnel, facilities, funds, and
anything else that can be used for providing health care services.
Resource Allocation

- Commonly viewed in terms of the use of equipment or other resources within the
institution
- the distribution of sources – usually financial - among competing groups of
people or programs.
- the process of identifying and managing resources

Priority Setting: involves a process of choice among alternative health care

programs and services that can be offered, and among the patients or groups
of patients who are to receive care
Priority Setting Criteria:

 Behavior: priority to those who have not become ill by own fault.
 Instrumental value: priority to those who have essential roles for
keeping society operational (e.g., hospital staff).
 Monetary: substantial contribution to the costs of the treatment.
 Order: according to the order of registration.
 Random: random selection, e.g., via a lottery.
  Service: contribution in the past to the common good (e.g., by
volunteering).
 Sickest first: the sickest individuals to be given priority.
 Survival: the likelihood to survive the longest.
 Youngest: prioritizing young individuals.
 Combination: a combination of criteria including age (youngest
first), and prognosis (longest survival with intervention).
Rationing: refers to the conscious decision to exclude certain people from a
service or treatment that they need.
Rationing takes many forms.

- It also occurs when deciding which patient on the waiting list gets an
organ transplant.
- Rationing is also utilized when prices are set for health insurance and
health services that some people cannot afford

Healthcare allocations are commonly classified in terms of two levels of decision

making: micro-allocation and macro-allocation.

 MACRO-ALLOCATION
- Macro-allocation decisions include how particular health-related institutions
such as hospitals or government agencies budget their spending (sometimes
referred to as meso-allocation).
- encompasses the decisions a nation makes concerning what resources to
devote to particular institutions or, more broadly, to high-technology curative
medicine as opposed to.
- Determine how much should be expended and what kinds of goods and
services will be made available.
- Macro-allocations problems are demonstrated in such questions as:
 What kinds of health care will be available?
 Who will get it, and on what basis?
 How will the costs be distributed?
 Who will deliver the services?
 Who controls these issues?
Two-Tier System and the Decent Minimum

- Under this approach, everyone would be guaranteed coverage for basic

care and catastrophic health needs. This coverage of a decent minimum of
 care would be distributed on the basis of need, with everyone being
ensured equal access.
- The second-tier, based on the ability to pay, would provide expanded and
perhaps better care at private expense.
MICRO-ALLOCATION

 Focuses on decisions regarding particular persons.

 It often involves "patient selection": determining which patients among those who
need a particular scarce resource, such as a heart transplant, should receive
treatment.
 More personal determination of who will receive scarce resources, such as
intensive-care beds, advanced technology, or organ transplants.

Triage: refers to the sorting of injured or sick people according to their need for
emergency medical attention. It is a method of determining priority for who gets
care first.

Responses and attempted solutions to the problem of limited healthcare resources:

Since health is valued very highly, there have been many attempts to reform the
system. These reforms have attempted to either increase the financial resources directed
to healthcare or to use limited resources in the best way possible. Reform attempts have
included efforts to:
1. Increase efficiency: By curtailing waste and unnecessary care, providers can be
more efficient.
- Methods include evaluating health technologies and expanding prevention
programs.
2. Distribute resources equitably: The basis of distribution is value-based and can
take many forms: strict equality, access to a determined level of care, access to an
 equal opportunity for care, limiting access to people responsible for their health
problems, and access based on age or other factors.
3. Adopt managed care plans: Managed care has been offered as an organizational
structure that hopes to distribute healthcare resources more efficiently and wisely
by having physicians review policies that balance the healthcare of the individual
patient (and the cost of caring for that patient) with the goals and costs of
providing healthcare to the entire group.

ISSUES INVOLVING ACCESS TO CARE

Health care access: is the ability to obtain healthcare services such as prevention,
diagnosis, treatment, and management of diseases, illness, disorders, and other health-
impacting conditions.

- POVERTY
- if you have plenty of money you usually have better access to healthcare
than others do. You will be able to afford insurance or have enough
money to pay for care privately.
- PhilHealth implements the National Health Insurance Program that aims
to provide Filipinos with financial assistance and access to affordable
health services. It covers hospital costs, subsidy for room and boarding,
medicine, and professional services

1. BARRIERS TO ACCESS
Examples:
 Not enough donor organs for transplant
 Not enough primary care physicians
 Country lacks healthcare professionals and facilities
 Limited hours, long waiting times, and limited afterhours care
 Insurance not available at affordable rates to certain populations
 Drug prices too high
 Patients already with high medical debts

2. HEALTHCARE RESOURCE ISSUES

- can be macro-allocation issues, micro-allocation issues, or somewhere in-
between.
 Macro-allocation issue: When the decisions are about large-scale
allocation within society or government.
 One broad macro-allocation issue is what priority the government
should place on healthcare amidst other areas competing for funding,
laws, and policies, for example, defense, education, and commerce.
  Slightly less broad issues concern how much to spend or focus on
prevention, treatment, and research
 to the level of individual institutions or healthcare systems, what
spending decisions should a hospital make about various healthcare
programs, building facilities, buying technology, outreach to the
community, etc.? Where should new clinics be stationed?
 Micro-allocation issues: When they are at the level of healthcare
professionals allocating time to specific patients.
 These issues arise in the delivery of healthcare from provider and
staff to patient.
 What new equipment should be purchased?
 How much staffing should the practice have, and at what level?
 For specific patients, how much time should the physicians and
nurses spend in the exam room, in patient education, in obtaining
tests?