Meaning and Service Value

of Medical Care

by: Venida, Joan M.

BSN II -B
 Value-Based Healthcare

Value-based healthcare, also known as value-

based care, is a payment model that rewards
healthcare providers for providing quality
care to patients. Under this approach,
providers seek to achieve the triple aim of
providing better care for patients and better
health for populations at a lower cost.
Value-based care focuses on care
coordination that ensures patients are
given the right care by the right
provider at the right time. Thus, in a
value-based healthcare model,
physicians may collaborate with each
other on a patient's care, rather than
making decisions separately that can
lead to gaps or overlaps in care.
 Why value-based care is
important

A value-based healthcare model

prioritizes patient-centered care. It
incentivizes healthcare providers to
get and keep their patients healthy,
which can in turn lower healthcare
costs.
 1. Allocation of Health Resources

What is Resource Allocation?

Health care resources are defined as all materials,

personnel, facilities, funds, and anything else that can
be used for providing health care services In many
other countries throughout the world, including those
with universal health insurance, health care is still a
scarce resource, and, therefore, strategies to allocate
health care resources are challenging and ever present.

https://pedsinreview.aappublications.org/content/
38/7/320
 Ethical Principles in Making Health Care Allocation
Decisions

 Bioethical principles 

 Autonomy requires that patients can make medical

decisions free from coercion.


Nonmaleficence serves to analyze potential harms.

 Beneficence is aimed at the goal of providing and

encouraging positive steps to achieve the best medical
outcomes.

 Justice is used to examine the limits of medical resources.

 Case Applications of Ethical Principles of Health Resource
Allocation
Dr Mitchel is caring for Jon Wilson, a 6-year-old boy with
chronic abdominal pain. Dr Mitchel has performed a thorough
history and physical examination, pertinent laboratory tests,
and radiographic studies, none of which has yielded a specific
diagnosis. Jon is missing school and is becoming more
withdrawn. After seeing a child psychologist, who has added
nothing to the understanding of the abdominal pain, Dr
Mitchel decides to refer Jon to a pediatric gastroenterologist, a
decision partly based on the parents’ request for a referral to a
specialist. However, the Wilsons’ managed care organization
(MCO) only contracts with adult gastroenterologists. As a
provider through this MCO, money used to pay for out-of-
network consults would come out of Dr Mitchel’s incentive
pool. Should Dr Mitchel refer Jon out of network or to an adult
gastroenterologist?
 2. 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.
Many people do not have access to adequate
healthcare. Three important themes in healthcare
access are the problem of poverty, the many barriers
to healthcare access, and the question of healthcare
resource allocation.
 Poverty
Poverty can be thought of as not having enough of the resources needed for an
adequate quality of life, resources such as food, clothing, shelter,
education, and healthcare.  We usually obtain these resources by
purchasing them, so poverty is often seen as an income and wealth issue.

Many causes of poverty have been suggested, with some focusing on the
individual and some focusing on group or systemic factors.  Among the
most common causes or factors cited:

 Lack of education
 Lack of job skills
 Lack of natural ability and intelligence
 Lack of a country’s natural resources
 Lack of scientific knowledge
 Racial, ethnic, sexual, and age discrimination in employment practices
 Lack of infrastructure (roads, communication lines, efficient government,
healthcare facilities, education facilities)
 Corrupt or incompetent governments
 Warfare
 Natural disasters (floods, droughts, soil erosion,
hurricanes, earthquakes, climate change)
 Poorly developed economy; lack of industrialization
 Inefficient or ineffective economic systems stemming
from faulty theories
 Religious influences preventing attempts at alleviating –
belief in fatalism, acceptance of natural disasters as divine
punishment, belief that the political and economic system
is “God’s will”
 Pollution (especially water)
  Barriers to Access
 One way to look at the problem of healthcare access is in
terms of such factors as the following constituting
“barriers” to access:

 Not enough donor organs for transplant

 Not enough primary care physicians
 Not enough medical schools
 Urban blight and rural poverty limiting desirability of
those neighborhoods for medical practices
 No convenient and affordable transportation for poor
patients to get to remote medical offices or hospitals
 Patients cannot get time off of work
 Patients cannot obtain affordable childcare
 Limited hours, long waiting times, and limited afterhours care
 Insurance not available at affordable rates to certain populations
 Prohibitive copayment fees for certain services
 Drug prices too high
 Patients already with high medical debts
 Low health literacy
 Low level of computer skill
 Low level of computer and Internet access
 Undocumented residents from foreign countries having disadvantaged
legal status
 Native language of patient not available at local facilities
 Country lacks healthcare professionals and facilities
 Climate factors create disease factors that overwhelm limited healthcare
resources in tropical countries
 Superstitions, suspicions, and cultural factors create prejudices against
using Western medical techniques
 Overall poverty level of individuals, population segments, countries,
and continents
  Theoretical Approaches to Allocation
 Healthcare services are not free and unlimited.  In considering the
problem of allocation, societies face some fundamental decisions. 
Two distinct questions are:

 1. Does society have a moral obligation to provide healthcare to all?

 2. What is the most efficient and effective system for providing
healthcare?

 On the first question, some people think (a) healthcare is like any
other consumer product or service (blenders, oil changes, etc.) that
some people can afford and some people can’t.  (b) A different
perspective is that healthcare is a right that the government has a
moral obligation to provide to the entire population.  (A follow-up
question would be: what level of healthcare?).  (c) Somewhere in
between is the view that healthcare is a social good like highways,
education, and defense, and the government should distribute it
more fairly than by letting it depend on ability to pay.
 The second question focuses more on how to most
efficiently provide healthcare.  The usual assumption is
that those who think healthcare is not a right believe a
free market mechanism is the best system and those who
think healthcare is a right or a social good would go with
a government provided distribution.  Thus two
theoretical approaches usually identified are the
“libertarian” position (free market) and the “liberal,
social welfare, distributive justice” position (healthcare
as a right).  But this is not absolute.  One may believe that
healthcare is a right and yet believe a free market is the
best overall mechanism to provide it (the government
messing up everything it touches) or, in contrast, believe
no one has a right to healthcare but believe it works in
the most organized, coherent fashion if the government
handles it rather than being left to the “chaos” of the
market.
 Here are three traditional theoretical
approaches.

 Libertarianism:  Those with libertarian sympathies believe

government should for the most part stay out of healthcare and let it
operate as a free market.  

 Liberal, “social welfare” conception:  The liberal social welfare

conception supposedly stems from seeing healthcare as a social good
or moral right that the government should provide so as to ensure that
it is distributed fairly and no one is left out.

 Efficiency:  Others think healthcare should be allocated for optimal

efficiency, to get the most “bang for the buck.”  Presumably this can
be taken to extremes so that no considerations of fairness enter into it.
 https://medicine.missouri.edu/centers-institutes-labs/health-ethics/
faq/health-care-accesst.