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Reflections for transforming health care models

Reflections for transforming health care models

Health care is a major expense for the health system, representing about $ 6 trillion worldwide.

Icono Autor Nancy Yomayusa. |  icono fecha 05 February 2019

On average, US $ 4,000 per person (adjusted for purchasing power, PPP) in OECD countries with an expected increase of 4.1% annually between 2017 and 2021.

Colombia is not a stranger to this trend. In the last two decades health spending increased from 5.9% to 8% of the GDP, with a slight increase in life expectancy (76.2 years), but still below the OECD average (80.6 years) However, the country is located in the low spending  quadrant relative to the OECD average (9% of GDP) and with  lower life expectancy, even lower than other countries such as Chile, Japan and Spain, where best health indicators in relation to spending have been achieved. So. the challenge of Colombia will be to remain in the quadrant of low spending, increased life expectancy and greater efficiency, away from the high spending trend evidenced in the US (12.5% ¿¿of GDP to 17.1%), where about 40% of expenditure is derived from poor diet, cardiovascular disease and non-rational entry of new technologies. Despite the efforts of health systems and organizations to optimize their processes and quality standards, a marked inefficiency is observed in the cost-benefit ratio of health care models, which prevents the fulfillment of sustainable development goals.

According to the latest report of the World Health Organization (WHO), OECD and World Bank low quality health services  are delaying progress in improving health in all independent countries regardless of their income level. In all these countries prevail  misdiagnosis, medication errors, inappropriate or unnecessary treatment, unsafe practices and inefficient suppliers, resulting in a fragmented care with greater risks to patient safety.

The lack of standardization of care based on evidence, non-rational use of technology and advanced medical treatments increase costs and boost spending and limit financial sustainability. This scenario is sharpened against the trends of aging, chronicity, multi-morbid diseases caused by migration and other social determinants, which is an opportunity for change for Colombia, particularly now that it will be evaluated under efficiency parameters of the OECD, who emphasizes: "without quality health services, universal health coverage will remain an empty promise.  Economic and social benefits are clear and need to see a greater focus to research and  quality improvement.

Care based on the value differs from the traditional practice, where providers are paid based on the amount of health care services and are instead in transforming them into a service focused on helping people maintain or improve their health, preventing or delaying the onset of chronic diseases, managing complexity and disability with evidence-based practice, directing investment towards prevention, promotion and decisive primary care and lower health spending.

In this manner, health providers and payers would achieve efficiency and control costs and reduce risk by managing healthier populations. Hospitals  would receive payment adjusted  to quality of care, which would ensure continuous improvement, genuine commitment to safe care; the adoption of evidence-based standards transcending from a hospital management centered around processes to an attention focused on the needs of people to create better care experiences that will be reflected in sustainability, reputation and confidence in the system and people.

Payment based on the value also allows payers  to increase efficiency covering the integrated and comprehensive care in complete cycles of care. To achieve this, we must promote cultural change and critical thinking to regain leadership and empowerment of caregivers evolving from a traditional practice focused on the disease to a  model that integrates from primary care  that  specializes in the social and community  fields under the responsibility of a true team bedside care.

The Canadian Health Services Research Foundation showed that teams work best when they have a clear purpose and implement protocols and procedures that have been agreed upon and are transparent. It is not easy to make this transition to a value-based system, given the resistance to change and fear of financial providers and payers. It is necessary to emphasize the strengths for the sustainability of the system and legitimately to help people achieve a healthier lifestyle.

But, in order to achieve a verifiable change it is necessary the investment in science, research, innovation and technological transformation, allowing the integration of information systems and clinical records for rigorous monitoring of results, ensuring the transparency of the system, as well as to  renews human management resources that will promoted quality, leadership excellence and a systems that works for achieving common goals where individuals, families, communities, providers and payers are guarantors and true partners in healthcare and welfare of the people.