THE Association of Private Hospitals Malaysia (APHM) has expressed support for Health Minister Datuk…

THE Association of Private Hospitals Malaysia (APHM) has expressed support for Health Minister Datuk Seri Dr Dzulkefly Ahmad's proposal, presented in Parliament, that embraces a shift from pay-for-service to value-based healthcare, focusing on patient outcomes. This move is intended to streamline payment methods and improve healthcare outcomes, while also aiming to manage healthcare costs. Nevertheless, APHM recognises that medical inflation may persist due to various factors beyond hospital charges.

Private hospitals are already implementing various strategies to deliver value by ensuring the best possible care, with some institutions initiating Value Driven Outcome studies from 2021.

These studies are designed to align care delivery with the costs charged. Regrettably, payors have not yet adopted this model to assess the actual value of treatments, often limiting patient options based on the monetary costs alone.

APHM has examined the concept of value-based healthcare on a global scale, noting both the successes and failures of its adoption internationally. Some models, particularly those replacing fee-for-service systems, have achieved reductions in healthcare expenses. For instance, Germany and Taiwan have seen an arrest in the growth of healthcare costs through the implementation of global budgets.

In the UK's National Health Service (NHS), pay-for-performance schemes have led to some improvements in quality, and bundled payments have incentivised clinicians to anticipate and prevent complications.

The Netherlands and Japan have used capitation regimes to promote public health and prevention, encouraging healthcare providers to focus on preventive care. Additionally, integrated care systems have been deployed to enhance the management of chronic illnesses.

However, significant challenges and defects exist that could technically and operationally burden healthcare organisations during the transition from fee-for-service to value-based models.

A particular concern is the establishment of quality and outcome metrics, which could present difficulties.

The prospect of not meeting performance standards might lead to high-risk patients being underserved, as providers might shy away from them due to potential undertreatment or outright rejection.

The introduction of new payment models that transfer financial risk may deter both providers and payers. Patients, too, could resist changes to therapy access and provision.

The lack of compatible electronic health records and a fragmented healthcare system can hinder essential data sharing and interoperability needed for value-based models.

Additionally, there is apprehension that value-based methods could disadvantage low-income and impoverished healthcare providers.

Value-based healthcare payment systems hold promise but require meticulous planning, the engagement of all stakeholders, and the addressing of technical, organisational, and cultural barriers.

APHM anticipates that the Ministry of Health will undertake an extensive review of the public healthcare delivery system in line with value-based healthcare principles funded by tax, and hopes that private entities will be motivated to follow suit.

DATUK DR KULJIT SINGH

President, Association of Private Hospitals Malaysia