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SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ

Year 2021, , 1 - 21, 13.04.2021
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.

References

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  • Health Care Payment Learning & Action Network. (2017). Alternative Payment Model Framework. Erişim Adresi: https://hcp-lan.org/apm-refresh-white-paper/. Erişim Tarihi: 08.01.2020
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  • Henkel, R. J., & Maryland, P. A. (2015). The risks and rewards of value-based reimbursement. Frontiers of health services management, 32(2), 3-16.
  • Horner, B., Van Leeuwen, W., Larkin, M., Baker, J., & Larsson, S. (2019). Paying for value in health care. Erişim Adresi: https://www.bcg.com/publications/2019/paying-value-health-care.aspx
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  • Juniper, K. (2014). Risk-Sharing and Value-Based Approaches to Health Benefits. Benefit Magazine. Erişim Adresi: https://www.buchalter.com/publication/risk-sharing-and-value-based-approaches-to-health-benefits. Erişim Tarihi: 08.01.2020
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VALUE-BASED MANAGEMENT IN HEALTH CARE: VALUE-BASED PAYMENT MODELS

Year 2021, , 1 - 21, 13.04.2021
https://doi.org/10.35375/sayod.782858

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.

References

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  • Dunbar-Rees, R., Panch, T., & Dancy, M. (2014). From volume to value? can a value-based approach help deliver the ambitious aims of the NHS cardiovascular disease outcomes strategy?. Heart, 100(11), 827-832.
  • Elghrabawy, A. (2012). A contingency framework of enterprise governance in the UK: A value-based management approach. Doktora Tezi, Brunel University Brunel Business School.
  • Expert Panel on effective ways of investing in Health (EXPH). (2019). Defining value in “valuebased healthcare” (doi:10.2875/872343). Lüksemburg: Avrupa Birliği.
  • Fantini, B., & Vaccaro, C. M. (2019). Value based healthcare for rare diseases: efficiency, efficacy, equity. Annali dell'Istituto superiore di sanita, 55(3), 251-257.
  • Firk, S., Schmidt, T., & Wolff, M. (2019). Exploring Value‐Based Management Sophistication: The Role of Potential Economic Benefits and Institutional Influence. Contemporary Accounting Research, 36(1), 418-450.
  • Firk, S., Schrapp, S., & Wolff, M. (2016). Drivers of value creation—The role of value-based management and underlying institutions. Management Accounting Research, 33, 42-60.
  • Francavilla, C. (2019). Understanding the Impact of Care Delivery Models in Value-Based Payment. Medsurg Nursing, 28(5), 331-338.
  • Gabriel, L., Casey, J., Gee, M., Palmer, C., Sinha, J., Moxham, J., & Colegate-Stone, T. J. (2019). Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis. BMJ Open Quality, 8(2), 1-11.
  • Garvelink, M. M., & Van der Nat, P. B. (2019). Moving forward with Value Based Healthcare: The need for a scientific approach. European Journal of Surgical Oncology, 45(7), 1299.
  • Health Care Payment Learning & Action Network. (2017). Alternative Payment Model Framework. Erişim Adresi: https://hcp-lan.org/apm-refresh-white-paper/. Erişim Tarihi: 08.01.2020
  • HFMA. (2018). Research Report: Value-Based Payment Readiness. Erişim Adresi: https://www.hfma.org/topics/hfm/2018/april/60163.html Erişim Tarihi: 09.01.2020
  • Henkel, R. J., & Maryland, P. A. (2015). The risks and rewards of value-based reimbursement. Frontiers of health services management, 32(2), 3-16.
  • Horner, B., Van Leeuwen, W., Larkin, M., Baker, J., & Larsson, S. (2019). Paying for value in health care. Erişim Adresi: https://www.bcg.com/publications/2019/paying-value-health-care.aspx
  • Johnston, K. J., Wen, H., Schootman, M., & Maddox, K. E. J. (2019). Association of Patient Social, Cognitive, and Functional Risk Factors with Preventable Hospitalizations: Implications for Physician Value-Based Payment. Journal of general internal medicine, 34(8), 1-8.
  • Juniper, K. (2014). Risk-Sharing and Value-Based Approaches to Health Benefits. Benefit Magazine. Erişim Adresi: https://www.buchalter.com/publication/risk-sharing-and-value-based-approaches-to-health-benefits. Erişim Tarihi: 08.01.2020
  • Kaplan, J., Kuenen W. J., Pykosz, M., & Larsson, S. (2013). Alternative payer models show improved health-care value. Erişim Adresi: https://www.bcg.com/publications/2013/health-care-payers-providers-alternative-payer-models.aspx
  • Keswani, A., Koenig, K. M., & Bozic, K. J. (2016). Value-based healthcare: part 1—designing and implementing integrated practice units for the management of musculoskeletal disease. Clinical Orthopaedics and Related Research®, 474(10), 2100-2103.
  • Khazanie, P., & Ho, P. M. (2019). Leveraging Value-Based Payment Models to Reduce Sex Differences in Care. Circulation: Cardiovascular Quality and Outcomes, 12(8), 1-3.
  • Koller, T. (1994). What is value-based management?. The McKinsey Quarterly, (3), 87-102.
  • Lakdawalla, D. N., Doshi, J. A., Garrison Jr, L. P., Phelps, C. E., Basu, A., & Danzon, P. M. (2018). Defining elements of value in health care—a health economics approach: an ISPOR Special Task Force report [3]. Value in Health, 21(2), 131-139.
  • Larsson, S. & Tollman, P. (2017). Health care value problems and how to fix it. Erişim Adresi: https://www.bcg.com/publications/2017/smart-simplicity-health-care-value-problem-how-fix-it.aspx
  • Lovata, L. M., & M. L. Costigan. 2002. Empirical analysis of adopters of economic value added. Management Accounting Research, 13 (2): 215–28.
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There are 75 citations in total.

Details

Primary Language Turkish
Subjects Business Administration
Journal Section Makaleler
Authors

Koray Kopuz 0000-0002-7985-8338

Eren Akman 0000-0002-6895-851X

Publication Date April 13, 2021
Published in Issue Year 2021

Cite

APA Kopuz, K., & Akman, E. (2021). SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ. Sosyal Araştırmalar Ve Yönetim Dergisi(1), 1-21. https://doi.org/10.35375/sayod.782858
AMA Kopuz K, Akman E. SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ. SAYOD. April 2021;(1):1-21. doi:10.35375/sayod.782858
Chicago Kopuz, Koray, and Eren Akman. “SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ”. Sosyal Araştırmalar Ve Yönetim Dergisi, no. 1 (April 2021): 1-21. https://doi.org/10.35375/sayod.782858.
EndNote Kopuz K, Akman E (April 1, 2021) SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ. Sosyal Araştırmalar ve Yönetim Dergisi 1 1–21.
IEEE K. Kopuz and E. Akman, “SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ”, SAYOD, no. 1, pp. 1–21, April 2021, doi: 10.35375/sayod.782858.
ISNAD Kopuz, Koray - Akman, Eren. “SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ”. Sosyal Araştırmalar ve Yönetim Dergisi 1 (April 2021), 1-21. https://doi.org/10.35375/sayod.782858.
JAMA Kopuz K, Akman E. SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ. SAYOD. 2021;:1–21.
MLA Kopuz, Koray and Eren Akman. “SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ”. Sosyal Araştırmalar Ve Yönetim Dergisi, no. 1, 2021, pp. 1-21, doi:10.35375/sayod.782858.
Vancouver Kopuz K, Akman E. SAĞLIK HİZMETLERİNDE DEĞER TEMELLİ YÖNETİM: DEĞER TEMELLİ ÖDEME MODELLERİ. SAYOD. 2021(1):1-21.