On behalf of the European Commission, international health experts are now making a series of recommendations designed to place reallocation in healthcare systems on a real, value-based foundation. With the current pressure to utilize resources more efficiently, they believe that the European solidarity-based healthcare system can only be sustained in this way. The Ludwig Boltzmann Institute for Health Technology Assessment (LBI-HTA) from Vienna was represented on the Panel by its director, Priv. Doz. Dr. phil. Claudia Wild.
According to an OECD* estimate, 10 to 34 percent of healthcare resources are wasted. In view of the increasing scarcity of resources, there is concern that universal health care may be endangered as a result of misused resources. Value-based healthcare is increasingly being discussed as a solution. This “value-based health care” designates a strategy to use healthcare resources where they create the most value. But just how precisely this (added) value is defined remains unclear among experts and in public debates. The European Commission has asked high-profile international health experts to analyse how this value is defined and how the value-based healthcare approach can contribute to a more effective, accessible and sustainable healthcare system. A representative of the Ludwig Boltzmann Institute for Health Technology Assessment (LBI-HTA) in Vienna is participating on the Panel.
Solidarity As a Fundamental Value Of European Healthcare Systems
“In short, we recommend defining value-based healthcare along the guiding principles of solidarity-based healthcare systems in Europe”, says Priv. Dr. Doz. Claudia Wild, Director of the LBI-HTA, and its representative on the Expert Panel. “We thereby propose an alternative to the definitions currently under discussion that relate health outcomes to monetized inputs and to individual patient experiences”. In fact, the Panel experts found these definitions — some of them originating from the US — to be too narrow and to disregard the solidarity aspect of European healthcare. These experts are of the opinion that value-based healthcare should instead rest on four value pillars:
1. Personal value: Appropriate care to achieve patients’ personal goals.
2. Technical value: Achievement of best possible outcomes with available resources.
3. Allocative value: Equitable resource distribution across all patient groups.
4. Societal value: Contribution of healthcare to social participation and connectedness.
Awareness About The Value Of Solidarity-Based Healthcare Systems Creates Sustainability
The financial sustainability of the general healthcare system was also analysed by the experts, who now suggest a long-term strategy of resource reallocation. This is based on the development of a greater awareness of health as an essential investment in the well-being of European society—but also on the establishment of a consistent language when dealing with relevant terms such as “waste”, “in/appropriate care”, “in/equity and equal access” and many more. Dr. Wild states: “We also recommend the training of ‘change agents’, that is, leaders who are to significantly support and shape this process, as well as investments in piloting, monitoring and evaluating the reallocation and shifting of resources”.
Further recommendations of the EC Expert Panel on Effective Ways of Investing in Health (EXPH) include:
• Promoting R & D on the appropriateness and overprovision of health care.
• Establishing communities of practice to compare practices and to encourage health professionals to take responsibility not just for individual patients, but patient groups.
• Supporting patient initiatives with unbiased, objective information to enable informed decisions.
All in all, the experts’ recommendations give the international debate on value-based health care a new perspective that is tailored to the European social order. The appointment of an LBI-HTA representative to the internationally renowned committee underlines its international reputation in the field of health technology assessments.
Expert Panel on Effective Ways of Investing in Health (EXPH) 2019: Defining value in “value-based healthcare”. Opinion. Available at https://ec.europa.eu/health/expert_panel/sites/expertpanel/files/ev_20190604_frep_en.pdf
*OECD 2017: Tackling Wasteful Spending on Health. Report. Available at https://www.oecd.org/health/tackling-wasteful-spending-on-health-9789264266414-en.htm