The Prospects of Transition of Control and Payment of Healthcare Within the Concept of Value-Based Health Care

Today, within the framework of the current law, control and payment for medical care is carried out by the results of treatment at individual stages (inpatient, outpatient cases, etc.). The elements of control and payment are “surrogate” indicators for the immediate results of treatment while the important outcomes for patients, including long-term results, are not measured. In addition, due to lack of tools of stimulating instruments for doctors with the view to improve the quality of medical care has a negative impact on the results of treatment. The reorientation of the quality control and payment mechanisms of medical care in the framework of value-based healthcare (VBHC) will help to create a transparency of the treatment, and will increase competition between medical organizations, and doctors. Currently, a new approach, VBHC, is being implemented in OECD countries, based on a direct link between the treatment costs and results that are important for the patient. VBHC allows to quantify clinical outcomes and correlate them with other important parameters, such as economic and social benefits. The goal of the study is “Development of approaches to the implementation of value-oriented health care in the conditions of Russian health care” The study identified the following objectives: 1) Analysis of the dynamics of the transition from traditional payment methods of medical care to value-based; 2) Analysis of regulatory documents governing the quality assessment and financing of medical care in the Russian Federation; 3) Analysis of international experience in the implementation of VBHC; 4) Analysis of the merits, obstacles and risks of the introduction of VBHC in the conditions of Russian health care; 5) Development of proposals and stages of implementation of VBHC in the Russian Federation. The main barriers to the implementation of VBHC were identified: lack of motivation due to conservatism and lack of knowledge in the field of modern global trends in quality control and the system of payment for medical care, both at the level of medical professionals and medical organizations and doctors; the lack of an appropriate IT solutions in medical organizations that is necessary for the implementation of VBHC; the mechanism for financing VBHC projects has not been defined, since the main sponsors are representatives of the industry, whose interests usually lie in the plane of short-term projects, while the main support center is a permanent process. In accordance with the international experience and the experience of personal observations of the authors, the ways of overcoming the described barriers have been developed: to motivate and inform project participants, it is necessary to conduct educational events, trainings, etc.; suggested the solution of developing the IT solutions required for VBHC; the problem of sponsorship of projects is solved by the effective implementation of the project, according to the results of which participants will be motivated, trained and personally interested in continuing of VBHC. The introduction of VBHC approaches into the Russian health care system allows optimizing approaches to quality control and payment for medical care and will contribute to the development of competition through the rating of medical organizations and doctors.