All health services committed to universal healthcare are hoping for a reduction in pressure after an intense year of intense pressure caring for people affected by acute Covid-19 infections. However, even if the pressure of Covid were to disappear, the next year will see a return to what appears to be an apparently inexorable growing pressure from:
- increasing need;
- rising demand;
- limited resources, not only financial but, as the pandemic highlighted, other finite resources notably staff time, beds, operating theatres and equipment;
- increasing restrictions on carbon.
The challenge will put pressure on their commitment to provide universal healthcare but how can this gap between need and demand, and resources be closed?
Great progress has been made in healthcare over the last 40 years, most of which has been achieved through technological advances in treatments, complemented by a succession of paradigms focusing on:
- Preventing disease, disability, dementia and frailty to reduce need.
- Improving outcome by providing only cost-effective, evidence-based interventions.
- Improving outcome by increasing quality and safety of process.
- Increasing productivity by reducing cost.
These all continue to be necessary but more of the same, even if it is better quality and safer care, is not sustainable. We need a new paradigm that focuses on value with a culture of stewardship, but what does value mean? In the USA, the meaning of the term ‘value’ is conceived as the relationship between outcomes for the patient treated and costs but in countries committed to universal health coverage this relationship would be termed ‘efficiency’ and in health systems committed to universal coverage, value is a much broader concept than efficiency. The European Union emphasised the need to understand that the commitment to universal healthcare is an expression of the principle of solidarity which is a core principle of the European Union. Their definition of value-based healthcare is that it is as a:
“Comprehensive concept built on four value-pillars:
- appropriate care to achieve patients’ personal goals (personal value),
- achievement of best possible outcomes with available resources (technical value),
- equitable resource distribution across all patient groups (allocative value) and
- contribution of healthcare to social participation and connectedness (societal value).”
The same principles were adopted by the G20 Health Ministers and the G20 is setting up a Global Hub to support all its members develop value-based healthcare. In England, ‘value for money’ as well as productivity was one of the important purposes of health systems defined in the policy ‘White Paper’ issued by the NHS in 2021 in preparation for the Health and Care Bill.