The transition to a new value-oriented healthcare model has been discussed all over the world in recent years. It is assumed that this will make medical care more effective, focused on a specific result, and not on the volume or quantity of services provided. Among other things, representatives of the national health care system discussed the new model at the “Solutions to Social Problems” forum held in Moscow in early June. Izvestia got acquainted with the arguments of the participants of the event, and also talked about what this could mean in the first place and when it is worth waiting for such an approach in Russia.
“A complex of desires, sensations, preferences”
Value-Based Healthcare (VHC) is seen mainly as an alternative to classical health care.system adopted today.
The traditional health care system does not take into account the achieved results of treatment, the focus is on the volume of medical care. While the CPH is based on monitoring the final results of medical care and monitoring the costs of providing care to a particular patientDmitry Shchurov, Deputy Head of the Development and External Communications Department of the Center for Expertise and Quality Control of Medical Care (CEKKMP) of the Russian Ministry of Health, explained to those gathered at the forum.
This, in his opinion, allows you to increase the effectiveness of treatment and reduce the costs of medical institutions.
A personalized approach to the patient is important, including for the physicians themselves, Adviser to the Director General of the International Medical Cluster Fund Yaroslav Ashikhmin is sure. Growing the chances of a complete cure and the possibility of reducing the degree of sufferingin its turn, protect them from burnout and help maintain their professionalismhe believes.
We are talking about a new paradigm for the development of modern medicine, which is being actively implemented in all countries of the world.Fatima Tamaeva, chief physician of the L7 mammological center, explained to Izvestia.
— This strategy involves a shift in focus from the volume of diagnostic and therapeutic measures performed to the quality of medical care provided.. The focus is on patient’s health in the context of not only physiological signs and clinical conditions, but also a complex of sensations, desires and preferences of a personwhich ultimately affects the results of treatment and the level of patient satisfaction, – explains the interlocutor of the publication.
As a result, the defining concepts of such an approach to healthcare are “expectations”, “interest”, “satisfaction”, “feelings”, “prevention of emotional burnout of medical workers”, “communication”, “image of a doctor”, she believes.
Photo: RIA Novosti / Kirill Braga
The transition to an improved health care model is primarily due to outdated criteria for evaluating the effectiveness of the traditional concept, most experts agree.
“Don’t miss the doctor”
At the same time, payment for services rendered is also based not only on the results of treatment, but also on the quality of life of patients and the level of satisfaction of their needs and expectations.explains the chief physician of the St. Petersburg city hospital No. 15, the chief hematologist of St. Petersburg Andrei Novitsky.
— Unlike the traditional financing model, when the feasibility of diagnostic and treatment measures is assessed by specialists from supervisory authorities, insurance companies, and so on, based either on patient complaints or some sort of selective analysis of treatment cases or case histories, in this model, when forming the final payment, it is assumed that the patient’s opinion is taken into account– he said in a conversation with Izvestia.
One of the goals of this model, according to him, “after all the optimizations,” is to reduce the cost of medical care.
The introduction of such a concept may be relevant for all clinical branches of medicine, but it is important to start the process of transition to it first of all in areas with the highest number of deaths.. This includes oncology and cardiovascular diseases, Tamaeva is sure.
Photo: RIA Novosti / Anton Vergun
Similar projects are already being implemented in Russia today, but in a targeted mode – including under the auspices of the CECKMP, there is a project for the treatment of inflammatory bowel diseases, a pilot project for the treatment of eye cataracts was completed earlier, in which four branches of the intersectoral scientific and technical complex “Eye Microsurgery” and the Konovalov Ophthalmological Center participated. Such approaches are practiced, including in some cases in the treatment of cancer patients.
“Today, the Public Health Center has made a big step in medicine, including oncology, including a new procedure for providing medical care and the availability of expensive funds,” said Elena Bobrova, First Deputy Director of the Territorial Fund for Compulsory Medical Care of the Moscow Region.
At the same time, Irina Borovova, president of the interregional public organization Association of Oncological Patients Hello, Irina Borovova, speaking at the forum, noted that the concept of personalized medicine today “causes controversy among patients,” including cancer patients.
The point is that not all patients with cancer today receive the same amount of assistance, Borovova explained. At the same time, the healthcare system as a whole and its financing today does not keep pace with innovations in oncology.
“If we want to see personalized treatment for patients, we must enable doctors to use all available opportunities more widely, including in order to avoid aggravating the disease or even its occurrence,” she emphasized. “This is the medicine of the future, which is based on a colossal personification of treatment. Now millions of rubles are being spent, but we do not always have effective treatment.
Photo: RIA Novosti / Sergey Pyatakov
At the same time, when switching to a new system, one should not forget about the sufficient motivation of doctors, Elena Bobrova emphasized.
— The question is how ready the doctors and patients themselves are for the CPH. We cannot bypass the doctor, the problem of his professional burnout, we need to provide assistance to both the middle and junior medical staff,” she noted.
Among the main components of value-based healthcare Dmitry Shchurov called the digital infrastructure, an integrated approach to the treatment of patients and remuneration of physicians for concrete results.
For the widespread implementation of the principles of value-based healthcare, it is necessary to informatize all medical processes, analyze the system of medical services provided, assess the cost structure within the framework of the compulsory medical insurance system, modernize the processes of quality control of medical careform a rating of medical organizations, develop a mechanism for obtaining feedback from patients, lists Fatima Tamaeva.
Introduction of a values-based approach as the basis of the healthcare system in Russia may require a “significant reorganization” of the entire healthcare systemAndrey Novitsky notes.
Photo: TASS/Valery Matytsin
The main obstacle to the development of this model may be the existing system of financing through compulsory medical insurance, which in its current form will not allow the use of such a model.
– It is necessary to change the system of providing medical care in the primary link – polyclinics, to change the concept of work in hospitals. Change the principles of financing medical institutions, change tariffs, legislation, introducing such assessments of the effectiveness of patient treatment as “quality of life”, strengthen preventive work in primary care,” he lists. — That is, in this case, quite serious work is to be done at the systematic methodological level.
At the same time, the concept itself resonates with the principle of the Russian therapeutic school founded by Professor Sergei Botkin – “to treat not the disease, but the patient,” recalls Novitsky.
“broad concept”
At the same time, the concept of value-based medicine itself is very broad. Therefore, it is not so much a term as a conceptual concept, the director of the Institute of Health Economics noted in a conversation with Izvestia National Research University Higher School of Economics Larisa Papulich.
– Here much depends on who exactly is the subject, whose values we are talking about. In some cases, for example, the values of the doctor and the patient may differ – the patient may be interested in the most easy and painless treatment, and the doctor in performing the operation that is necessary in this case, she recalled. — In this case, the characteristics of such value-oriented assistance may differ.
When it comes to patient-centered medicine, care must be safe, adequate, fair and consistent.the interlocutor of the publication draws attention.
Photo: RIA Novosti / Sergey Guneev
If we focus on the values of the doctor providing care, then the main values u200bu200bwill be access to the most modern technologies and the opportunity for professional development.she believes.
To a greater extent, today such a model may be in demand in areas requiring a multidisciplinary approach. – for example, in the treatment of cancer patients or patients with hematological diseases, Andrey Novitsky confirms.
However, it is precisely here that a contradiction can be observed between the patient’s condition and the effectiveness of treatment. So, due to side effects from aggressive chemotherapy, the patient’s well-being and quality of life may deteriorate, while the patient is in remission for cancergives an example of a doctor.
– If we are talking about medicine from the point of view of the budget, because this area in absolutely any country in the world resembles a “black hole” that can absorb all the allocated funds, then here the main value will be the achievement of the maximum result at the minimum cost– says Papulich.
Photo: TASS/Gavriil Grigorov
Value-Based Health is often viewed primarily from this perspective.. However, it must be remembered that this concept includes an umbrella system of many components. And when it comes to such an approach, you need to consider each of these parameters, the expert argues.
“But the most important thing we can say is that the patient, faced with the healthcare system, should not be left alone. Someone should lead him, accompany him throughout this journey, – sums up the interlocutor of the publication.
