Guest Editorial: Is There Value in Value-based Health Care?

Comparison of current relative value unit-based prices and utility between common surgical procedures, including orthopedic surgeries, in South Korea

“…CEA has drawn attention to the importance of overcoming the problems of the current medical pricing system [ 5 ]. This was an attempt to measure the appropriate price compared to the effectiveness or utility of a medical procedure, where effectiveness is most frequently evaluated by QALY gain.…”

“…Determining the cost of a specific surgical procedure is debatable and problematic. To assess surgeons as providers of medical services, the relative value units (RVUs) could be a feasible model reflecting their work intensity, time, and equipment investment [ 4 ], while the cost-effectiveness model could be used to assess patients as consumers of medical services that provide equivalent utility to the payment [ 5 , 6 ] The quality-adjusted life year (QALY) has been a useful tool for evaluating the effectiveness of medical services, which is life expectancy adjusted for health-related quality of life [ 7 ].…”

“…In a traditional fee-for-service system, physician reimbursement is compensated regardless of the treatment outcome or patient satisfaction [ 8 ] To overcome this limitation, upcoming healthcare reform in South Korea seeks to transform the current medical fee schedule paradigm into a pay-for-performance or value-based purchasing (VBP) [ 9 – 11 ] Despite the emergence of VBP and its potential efficacy, the transition from fee-for-service to pay-for-performance has only made slow progress and encountered barriers due to the lack of consensus on which measurement represents the patient satisfaction the best [ 8 , 12 ] Recently, with the increasing demand and interest in patient rights, cost-effectiveness analyses (CEA) based on QALY measurement have emerged as a possible answer to this challenge [ 5 ].…”

Routine Type and Screens Are Unnecessary in Primary Total Joint Arthroplasty: Follow-up After a Change in Practice

“…Institutions have begun updating protocols for use of blood products and related testing to minimize unnecessary costs without sacrificing patient safety. In the era of value-based health care and the bundle payment model, reduction of unnecessary testing allows for resource rollover to interventions that create value for the patient, including implant costs and postoperative rehabilitation [ [10] , [11] , [12] ]. Previous studies have found cost savings of nearly $200 per patient and potentially hundreds of millions annually across the U.S. health care system [ 9 , 13 ].…”

Primary Care of the (Near) Future: Exploring the Contribution of Digitalization and Remote Care Technologies through a Case Study

“…Pay-for-performance, value-based schemes and outcome-driven remuneration should not end up making some patients and diseases overlooked because of cherry-picking drifts, i.e., because they are too difficult to treat, because they are affected by concomitating irreversible conditions or because health status progression is hard to measure [67]. In value-based care, "value" does not mean profitable patients, but relevant improvement for real-world patients, be it functional recovery, regression slowdown or pain control (i.e., palliative care), at sustainable costs by the payor and the community (which are equivalent in an NHS).…”