What does the concept of value mean when we talk about health care? This is one of the questions Dr. Jason Sutherland has wrestled with over the past decade. The answer likely depends on who you ask: patients, providers, or payers.
Dr. Sutherland, who is the Program Head of Health Services and Outcomes at CHÉOS, has focused his research on understanding the payer’s perspective of funding health care in B.C., across Canada, and the United States.
“My program of research looks at system and patient-level effects of funding policies with the overall objective of identifying strategies for improving access, continuity, and efficiency of care” he explained.
Identifying and evaluating policy options to improve our health system is critical, he says. The skyrocketing cost of providing health care shows no signs of slowing as the demands on the system steadily increase.
“We have some of the highest medical spending in the developed world but we lag behind on indicators that are important to patients,” noted Dr. Sutherland “My work involves understanding if we are able to improve value from health care by allocating money differently.”
The most common model for funding hospitals – the most expensive component of health systems —is what’s called a global budget, where a set amount of money is provided to a hospital to cover operating expenses for a set amount of time. However, research has shown that this model, used in B.C., doesn’t create incentives to improve access or care, incentivizing hospitals to keep costs low, limit initial patient intake, and delay discharge of low-cost patients.
Other options include an activity-based model, where hospitals are funded on a per-case basis. “This type of funding structure, used in Ontario, has been shown to incentivize increased volume and shorter length of stay,” he said. But, he cautions, each funding model has drawbacks.
“My work involves understanding if we are able to improve value from health care by allocating money differently.” — Dr. Jason Sutherland
At the crux of this issue is identifying how and when to measure value and track changes in the health system over time.
“Most often, we use the attributes of the health system that are the simplest to measure, like growth, capacity, or wait times” he said “But, these don’t necessarily capture the value delivered by the system.”
“We don’t do enough to measure health and quality of life in a standardized way over the long term,” he added.
While none of these approaches are perfect, learning from what others have done will help to support the implementation of evidence-based changes to our own health systems to allocate spending more effectively.
At the upcoming Work in Progress Seminar on January 15, Dr. Sutherland will be discussing how evidence regarding funding policies and current mis-allocations can be used in provincial and federal efforts to move towards a value-based health system.