Introduction
Healthcare is one of the critical components of society’s life. Considering the future of this field is necessary to understand what shortcomings the medical industry has at the moment and determine ways to limit them. This work makes the assumption that changing the fee policy for medical services to introduce a value-based care system may have the most excellent effectiveness. Despite the fact that, at the moment, there is a small amount of research on the traditional policy of fee-for-service, the introduction of cost-effective methods is of interest for analysis. The main argument in favor of the proposed alternative is the reduction of health risks and the transition to a more patient-centered practice.
Fee for Services
Canada is known as a country that has one of the best and most advanced health care systems. The main characteristic features are decentralization and public funding called Canadian Medicare. Thus, the healthcare system is funded by thirteen provinces and regions of the country. Another feature is that each of them has its insurance plan and provides cash assistance from the federal government on a per-capita basis.
Despite the fact that the medical sector in the country is famous for its quality, a comprehensive assessment of its status shows the need to introduce changes. They are necessary to improve the overall health status of the population and the well-being of life, which require raising the role of value of healthcare services. Nevertheless, an approach that conditions a medical visit considering only one medical problem limits the previously mentioned aspects. In particular, attention should be paid to the so-called “fee-for-service” system. This policy implies a billing system, which implies the provision of a certain amount to medical specialists from the state instead of the generally accepted approach of paying wages (). There is evidence that “in 2016-2017, fee-for-service payments made up about 45 percent of GP payments in Ontario” (“International health care system profiles”, n.d., para. 29). The policy under study thus restricts doctor visits to one disease or complaint, which may have several risks both for patients and for the entire system as a whole.
One of the main risks when adhering to the fee-for-services system is the fact that most patients begin to independently investigate their symptoms and diagnose themselves. This circumstance can lead to improper medication intake and deterioration of health. Multiple scientific studies have proved that insufficient awareness and self-diagnosis can play a critical role in aggravating the situation with a decrease in the quality of life of society (Ćirković, 2020). Another justification is rational care, which is caused by the limitations of some medical services to specific segments of society (“Healthcare rationing”, n.d.). For example, if all issues of a single patient are brought up during the appointment, it would be unfair to other patients on the waiting list. Another critical risk to health care is the abuse of their powers by some doctors. Furthermore, they can assign unnecessary treatments and expensive tests given that they are paid on a fee-for-service basis and reimbursed at a higher amount.
It is also worth noting that due to the fact that patients are limited to one appointment with a medical specialist, communication problems may arise. This aspect is of particular value as it determines the further course of treatment and forms the relationship between society and the healthcare sector. Thus, the lack of a properly constructed information exchange process between a doctor and a patient can lead to dissatisfaction with the patient’s unmet needs and may lead to a poor diagnosis. Subsequently, this may be the result of poor care and treatment, which is especially dangerous for representatives of the elderly population, whose list of needs is relatively high.
Thus, in order to summarize the reasons given in favor of introducing an alternative, it is essential to note that the built system of one visit-one problem is incorrect since comprehensive assessment takes time, and its lack can lead to the omission of serious medical concerns. In addition, the establishment of a proper level of communication between medical specialists and patients suffers, which leads to self-diagnosis of diseases and incorrect treatment. The next factor is that the elderly population requires a more detailed and in-depth examination.
Value-Based Care
The proposed alternative to the fee-for-services policy applied in Canadian healthcare institutions is the use of value-based healthcare (VBHC). The main positive feature of this approach is the centralization of attention to patients, their complaints and needs. Another advantage of VBHC, which is emphasized in the sources, is the fact of improving the quality and efficiency of the medical services provided and a significant reduction in expenses (McCaughey et al., 2019). The component that helps to achieve this feature is that VBHC estimates the costs of providing certain services, paying particular attention to the achieved results of treatment. This is what distinguishes this approach from the traditional method of paying for the service upon its provision without taking into account positive or negative outcomes. VBHC focuses on the funds spent on medical care with its results, which are essential for patients.
However, it is also worth highlighting that despite the theoretical ease of application of the alternative under study, in practice, it may also have some difficulties. The main ones are isolated sources of funding for healthcare institutions, cultural resistance, and payments based on activities and services. Moreover, at the moment, there is an insufficient amount of analytical data that would prove the effectiveness of the application of this policy. Since evidence-based scientific experiments are vital, many countries shy away from the immediate implementation of VBHC in their health care delivery systems.
However, the most beneficial place to switch to VBHC may be hospitals. Research stated that “at present, about ten to fifteen percent of hospital beds are filled with patients who can’t be discharged due to lack of community support” (Wilson, n.d., para. 3). These statistics confirm the fact that value in terms of health outcomes and cost could be increased if a service were bundled to include short-term care at home (“Value-based healthcare”, n.d.). Conditions already exist in Canadian medical institutions for the introduction of alternative policies in the practice of providing services. Hence, bundled payments are a widespread and well-known component of VBHC. This is due to the fact that they can be used in a limited way without interfering with the more extensive system.
Conclusion
In conclusion, this work was engaged in justifying the change of the traditional fee-for-service system to such an alternative as value-based healthcare. This assumption is based on the fact that the first approach has risks for all parties involved in the process of providing medical services. One of them is poor communication, a decrease in the quality of health and dissatisfaction with the needs of patients. The value-based practice has advantages such as focusing on patients and reducing costs. However, it is worth remembering that any changes have limitations and require careful and smooth implementation.
References
Ćirković, A. (2020). Evaluation of four artificial intelligence-assisted self-diagnosis Apps on three diagnoses: Two-year follow-up study. Journal of Medical Internet Research, 22(12), e18097. Web.
Healthcare rationing. (n.d.). Health Insurance. Web.
International health care system profiles: Canada. (2020). The Common Wealth Fund. Web.
Marston, Y. (n.d.). Canada merits moderate rating in international value-based healthcare report. Hospital News. Web.
McCaughey, D., McGhan, G., Bele, S., Sharma, N., & Ludlow, N.C. (2019). The quest for value in Canadian healthcare: The applied value in healthcare framework. HealthcarePapers, 18(4), 48-57. Web.
Value-based healthcare. (n.d.). The Conference Board of Canada. Web.
Wilson, T. (n.d.). The best healthcare is value-based. Hospital News. Web.