Name: Bellarmine T.

Millena
Level: II
Block: A
Topic: MEANING & SERVICE VALUE OF MEDICAL CARE;
ALLOCATION OF HEALTH RESOURCES; ISSUES INVOLVING
ACCESS TO CARE

MEANING AND SERVICE VALUE OF MEDICAL CARE

Michael E. Porter & Elizabeth O. Teisberg

- proposed a single unifying goal for health care: to deliver value for the patient.
- VALUE: defined as the outcomes that matter to patients and the costs to achieve
those outcomes.
- to achieve value for patients; health care delivery needed to be organized around
the medical conditions’ patients have, accurately measure the outcomes that matter
to patients, and measure the cost to achieve them.
VALUE-BASED HEALTHCARE

- Based on their work entitled: Redefining Health Care Creating Value-Based

Competition on Results (2006) by Harvard University Professor Michael E.
Porter and was co-authored by Elizabeth Teisberg
- Widely touted as critical to improving the health outcomes of patients
worldwide and controlling runaway health care costs
- Main Concept/Idea: is that value for patients must be the overarching
principle in the organization and management of health care delivery
systems.

Priority Setting: involves a process of choice among alternative health care

programs and services that can be offered, and among the patients or groups of
patients who are to receive care

Rationing: involves leaving some people, at least temporarily and against their
wishes, without particular forms of healthcare that might benefit them.

ALLOCATION OF RESOURCES
Health Care Resources: Defined as all materials, personnel, facilities, funds, and anything
else that can be used for providing health care services.
Resource Allocation

- Commonly viewed in terms of the use of equipment or other resources within the
institution
- the distribution of sources – usually financial - among competing groups of people
or programs.
- the process of identifying and managing resources
The fair and equitable division of scarce goods and services is usually considered an
issue of distributive justice.
Distributive Justice: refers to the fair, equitable, and appropriate distribution of health-
care resources determined by justified norms that structure the terms of social cooperation

Society has used a wide variety of criteria for the distribution of resources. But
certainly, does not exhaust the list of possible criteria.
Common methods for Distribution of Goods and Resources
• to each person an equal share
• to each person according to need
• to each person according to merit
• to each person according to contribution
• to each person according to effort
• to each person according to social worth
Healthcare allocations are commonly classified in terms of two levels of decision making:
micro-allocation and macro-allocation.

• MACRO-ALLOCATION
- Macro-allocation decisions include how particular health-related institutions
such as hospitals or government agencies budget their spending (sometimes
referred to as meso-allocation).
- encompasses the decisions a nation makes concerning what resources to devote
to particular institutions or, more broadly, to high-technology curative medicine
as opposed to.
- Determine how much should be expended and what kinds of goods and services
will be made available.
- Macro-allocations problems are demonstrated in such questions as:
✓ What kinds of health care will be available?
✓ Who will get it, and on what basis?
✓ How will the costs be distributed?
✓ Who will deliver the services?
✓ Who controls these issues?
 Two-Tier System and the Decent Minimum

- Under this approach, everyone would be guaranteed coverage for basic care
and catastrophic health needs. This coverage of a decent minimum of care
would be distributed on the basis of need, with everyone being ensured
equal access.
- The second-tier, based on the ability to pay, would provide expanded and
perhaps better care at private expense.

MICRO-ALLOCATION

- Focuses on decisions regarding particular persons.

- It often involves "patient selection": determining which patients among those who
need a particular scarce resource, such as a heart transplant, should receive
treatment.
- More personal determination of who will receive scarce resources, such as
intensive-care beds, advanced technology, or organ transplants.

Triage: refers to the sorting of injured or sick people according to their need for
emergency medical attention. It is a method of determining priority for who gets
care first.
Red: Needs immediate attention for a critical life-threatening injury or
illness; transport first for medical help.
Yellow: Serious injuries needing immediate attention. In some systems,
yellow tags are transported first because they have a better chance of
recovery than red-tagged patients.
Green: Less serious or minor injuries, non-life-threatening, delayed
transport; will eventually need help but can wait for others.
Black: Deceased or mortally wounded; black may not mean the person has
already died. It may mean that he or she is beyond help and, therefore, is a
lower priority than those who can be helped.

ISSUES INVOLVING ACCESS TO CARE

Health care access: is the ability to obtain healthcare services such as prevention,
diagnosis, treatment, and management of diseases, illness, disorders, and other health-
impacting conditions.

For healthcare to be accessible it must be affordable and convenient.

1. POVERTY
- if you have plenty of money you usually have better access to healthcare
than others do. You will be able to afford insurance or have enough money
to pay for care privately.
- PhilHealth implements the National Health Insurance Program that aims to
provide Filipinos with financial assistance and access to affordable health
services. It covers hospital costs, subsidy for room and boarding, medicine,
and professional services
2. BARRIERS TO ACCESS
Examples:
➢ Not enough donor organs for transplant
➢ Not enough primary care physicians
➢ Country lacks healthcare professionals and facilities
➢ Limited hours, long waiting times, and limited afterhours care
➢ Insurance not available at affordable rates to certain populations
➢ Drug prices too high
➢ Patients already with high medical debts
3. HEALTHCARE RESOURCE ISSUES
- can be macro-allocation issues, micro-allocation issues, or somewhere in-
between.
• Macro-allocation issue: When the decisions are about large-scale
allocation within society or government.
▪ One broad macro-allocation issue is what priority the government
should place on healthcare amidst other areas competing for funding,
laws, and policies, for example, defense, education, and commerce.
▪ Slightly less broad issues concern how much to spend or focus on
prevention, treatment, and research
▪ to the level of individual institutions or healthcare systems, what
spending decisions should a hospital make about various healthcare
programs, building facilities, buying technology, outreach to the
community, etc.? Where should new clinics be stationed?

• Micro-allocation issues: When they are at the level of healthcare

professionals allocating time to specific patients.
▪ These issues arise in the delivery of healthcare from provider and staff
to patient.
▪ What new equipment should be purchased?
▪ How much staffing should the practice have, and at what level?
▪ For specific patients, how much time should the physicians and nurses
spend in the exam room, in patient education, in obtaining tests?