I.Changing how we pursue health
As this course was being developed in early 2020, the global COVID-19 outbreak unfolded right before our eyes, affecting nearly every country and our individual lives. The virus spread quickly across the world, causing fear and uncertainty. Borders shut down, flights were suspended, schools, shops, and restaurants closed – and the ordinary lives people took for granted ground to a halt. When the virus spread too fast, even the health systems in high income countries struggled to cope.
The situation has been unprecedented in our lifetimes, and it was a drastic way for us to all recognize the significance of health and the impact it has on society as a whole.
Why a broader approach to health and healthcare is needed
As the creators of this course, we believe there is a need to re-examine the way people perceive health. Health is important to us all, and healthcare needs to fundamentally address this. Healthcare is not just about curing the sick, it’s about generating healthy populations through a robust and sustainable system.
Three major changes are taking place at the moment, and there is a need for healthcare to adapt to them:
- Firstly, there is demographic change. The population of the world is aging. People are living longer and disease epidemiology is in transition.
- Secondly, there is technological progress in every field, including medicine, pharmaceuticals, health systems, and information technology. Healthcare needs to stay up to date and make the best out of technological advances.
- And lastly, people are paying increasing amounts for healthcare and there is an urgent need to re-examine what they are paying for, how they are paying for it, and whether there is a better solution to obtaining healthcare more efficiently and effectively. Countries and people cannot just keep on paying more and more – the healthcare system needs to be made sustainable. The goal is to maximize value for money in healthcare, which means there is a lot that could be done to disrupt the status quo.
The problem of increasing costs
People are spending more and more on their health. Of the three issues raised above, we focus here on cost, as it increases with aging populations and new technological advances, and moreover it is the key focus of value-based healthcare. Total health spending is growing faster than gross domestic product (GDP), and in 2016, the world spent 7.5 trillion USD on health, representing close to 10% of global GDP. Health’s share of GDP is greatest in high income countries, at around 8.2% on average. Between 2000 and 2016, global spending on health increased every year, growing in real terms at an average annual rate of 4.0%, faster than the 2.8% annual growth of the global economy. In high income countries, public spending on health per capita went from an average of 1,357 USD in 2000 to 2,257 USD in 2016, a 66% increase.
In Finland, the total expenditure on health as a percentage of GDP mainly rose over the last four decades. The share was 5.9% in 1980, 7.2% in 1990, 6.7% in 2000, and a peak of 9.3% in 2016, where it has roughly stayed ever since.
What is more, there is reason to believe that the resources being put into health are not necessarily being used in the right way. An OECD report on “Tackling Wasteful Spending on Health” presented data on inappropriate care and wasted resources, with estimations ranging from a conservative 10% up to an alarming 34% of expenditure being wasteful. “Wasteful” means services and processes that are either harmful or do not deliver benefits, as well as costs that could be avoided by substituting cheaper alternatives with identical or better benefits. Wasteful spending can be caused by unnecessary clinical care, operational waste, or governance-related waste. The OECD report found that a significant share of health spending in OECD countries is at best ineffective and at worst wasteful. Some examples are as follows:
- The rates of cardiac procedures geographically can vary by up to 300% and knee replacements by up to 500%, but these variations are largely unwarranted
- Up to 50% of antimicrobial prescriptions are unnecessary
- 12% to 56% of emergency department visits are inappropriate
- The share of generics varies between 10% and 80%
- Administrative expenditure varies more than seven-fold
Over the next decades, based on past growth and future grown trajectory, we can assume that the absolute amount of money each of us will spend on health will increase. In Finland, both government health spending and out-of-pocket spending are expected to increase.
Are people simply going to keep spending more on health? Is it inevitable? Are people getting more out of such additional spending and is it value for money? These are the key considerations for a value-based healthcare approach.
What you will learn in this course
Value-based healthcare (VBHC) may not be the silver bullet to solve all healthcare problems, but we certainly believe that it can start a constructive discussion and be a step in the right direction for the future.
By taking this course, you will understand what is meant by value-based healthcare in each context and why it is relevant today. You will apply the value-based healthcare approach using Finland as a case study country. You will analyse the future of value-based healthcare through the perspective of each stakeholder and its overall implication for society – value-based healthcare is an evolving concept that challenges the way we see healthcare.
The course is primarily targeted at people working in the healthcare field (medicine, nursing, health administration, etc.). The secondary target group includes healthcare service providers, regional officials, health policy makers, pension funds, public and private insurers, large employers, and national health institutes. Even though the main target groups are health professionals, the course does not require specific prior knowledge and we welcome anyone who is interested in health, healthcare, and its implications for society.