The Association of Private Hospitals Malaysia (APHM) welcomes Health Minister Dzulkefly Ahmad’s proposal in Parliament for value-based health care rather than pay-for-service, with an emphasis on outcomes, to ensure efficient payment methods and health care outcomes while preventing health care inflation.
This is aimed at lowering health care costs, but it will not necessarily eliminate medical inflation, which is unavoidable due to a variety of causes other than hospital fees.
Currently, private hospitals are using a variety of approaches to provide value to patients by providing the best care possible, and some hospitals have begun Value Driven Outcome studies since 2021 to ensure that care is delivered in accordance with the value charged.
Unfortunately, payors do not use such a system to evaluate the true worth of therapy, but instead control facility options for patients based on the monetary amount paid.
We studied the notion of value-based health care globally. The global adoption of value-based health care payment schemes has been both successful and unsuccessful. Some models have lower health care expenses compared to fee-for-service models. Global budgets in Germany and Taiwan have halted health care cost growth.
In the United Kingdom’s NHS, pay-for-performance initiatives have increased quality to some extent, while bundled payments encourage clinicians to plan ahead of time to avoid complications.
Capitation regimes in Japan and the Netherlands have prioritised population health and prevention by pushing providers to engage in preventive care and integrated care systems enhance chronic illness treatment.
However, there are substantial problems and faults that may cause health care organisations to suffer technically and operationally while transitioning from fee-for-service to value-based models. Setting quality and result requirements, in particular, may prove problematic.
High-risk patients may be overlooked by doctors due to performance expectations, potentially leading to undertreatment or rejection. New payment mechanisms that shift financial risk can dissuade providers and payers. Patients may be opposed to changes in therapy availability and delivery.
Incompatible electronic health records and fragmented health care systems can impede data sharing and interoperability, which value-based models require.
Furthermore, value-based approaches raise concerns regarding the disadvantage of low-income and destitute providers and patients.
Value-based health care payment systems offer potential, but they necessitate careful planning, stakeholder engagement, and the resolution of technological, organisational, and cultural challenges.
We expect that the Ministry of Health will conduct a comprehensive study to review the public health care delivery system utilising value-based health care principles that are tax-funded and that private organisations will be encouraged to replicate.
Dr Kuljit Singh is president of Association of Private Hospitals Malaysia (APHM).
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