SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ

Year 2021, Issue: 1, 1 - 21, 13.04.2021

Koray Kopuz , Eren Akman

https://doi.org/10.35375/sayod.782858

Abstract

Günümüzde sağlık sektöründe hizmet başına ödeme modeli yaygın olarak kullanılmakta ve bu modelde ağırlıklı olarak hizmetin hacmi ödüllendirilmektedir. Hacmin ödüllendirilmesi, daha fazla hizmet sunumuna ve maliyet artışına neden olmaktadır. Sağlık alanında değer temelli yönetim yaklaşımı Porter ve Teisberg tarafından 2006 yılında ortaya konulmuştur. Bu yaklaşımın amacı yüksek değere ulaşmaktır. Değer kavramı ise paraya çevrilebilen girdilere göre sağlık sonuçları şeklinde tanımlanmaktadır. Değer artarsa sağlık sisteminin sürdürülebilirliği artar ve bütün paydaşlar bundan fayda sağlayabilir. Sağlık sektöründe pek çok alanda değer temelli yaklaşımlar kullanılmakla birlikte bunlardan bir tanesi de değer temelli ödemedir. Değer temelli ödeme modelleri, hizmet başına ödeme modelinin aksine, hastaneler ve hekimler de dâhil olmak üzere bütün hizmet sunucularını, olumlu sonuçlar üreten yüksek kaliteli ve uygun maliyetli bakım sağlamaları için ödüllendirir. Değer temelli ödeme modellerinin; ödül ve performans kriterlerinin belirlenmesi, ödemenin bir kısmının hizmet sunumu sonrası alınması, maliyetlerin ölçülmesi, paydaşlar arası koordinasyon sağlanması, taraflar arasında risklerin dağılımı gibi bir takım uygulama zorlukları bulunmaktadır. Ancak hizmet kalitesinin arttırılması, sağlık hizmeti maliyetlerinin düşürülmesi, ödeyici kurumlar açısından ödeme verimliliğinin arttırılması, kanıta dayalı bakım sağlanması, komplikasyonların azaltılması, bakım koordinasyonunun güçlendirilmesi ve geri ödemelerde artışın sağlanması gibi pek çok fayda sağlar. Bu çalışmanın amacı değer temelli ödeme modellerinin kullanımı ile ilgili genel bir çerçeve oluşturmak ve değer temelli ödemeye geçiş sürecinde dikkat edilmesi gereken noktaları ortaya koymaktır.

Keywords

değer temelli sağlık, değer temelli yönetim, değer temelli ödeme

VALUE-BASED MANAGEMENT IN HEALTH CARE: VALUE-BASED PAYMENT MODELS

Abstract

Today, the fee-for-service model is widely used in the health sector and the volume of the service is mainly rewarded in this model. Rewarding volume means more service delivery and more cost. The value-based management approach in health was introduced by Porter and Teisberg in 2006. The aim of this approach is to achieve high value. The concept of value is defined as health outcomes according to inputs that can be converted into money. If value increases, the sustainability of the health system increases, and all stakeholders can benefit. In many areas of the health sector, value-based approaches are used, but one of them is value-based payment. In contrast to the fee-for-service model, value-based payment models reward all providers, including hospitals and physicians, for providing high quality and cost-effective care that produces positive results. There are some implementation difficulties in value-based payment models; such as determining reward and performance criteria, receiving a portion of the payment after service delivery, measuring costs, ensuring coordination between stakeholders, distribution of risks between parties. But it provides many benefits such as increasing service quality, reducing health care costs, increasing payment efficiency for payer, providing evidence-based care, reducing complications, strengthening coordination of care and increasing reimbursement. The aim of this study is to create a general framework for the use of value-based payment models and to reveal the points to be considered in the transition to value-based payment.

Keywords

Value-Based Health, Value-Based Management, Value-Based Payment

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