Transforming health and social care systems: the role of regions in fostering value-based healthcare

Today’s challenge is to guarantee universal access and quality health care to all. These principles lay at the heart of European cohesion and public health authorities must protect them. To do so, health systems must transform towards a model where resources are not wasted but generate value for the benefit of patients, citizens, and society.

The combination of increasing demands upon healthcare, due to an aging population and rising prevalence of chronic diseases, and constraints upon funding, is resulting in big challenges for health systems across Europe. This is pushing all the competent public administrations in rethinking and assessing policy options in more depth to ensure effective, accessible, and resilient health and social care systems.

Through my work at the European Regional and Local Health Authorities (EUREGHA) network, it has become clear to me that there is a huge role for regions and local authorities to play in using value-based healthcare as a driver to foster innovation and transform health and social care systems across Europe.

EUREGHA is a Brussels-based network representing 18 regional authorities in 10 countries across Europe, whose overarching objective is: increasing health and social care systems sustainability, through advocacy activities and projects, including those influencing European policymaking. It is no surprise that, as stated in our campaign “Health in all Regions”, value-based health care is one of our top priorities, given its growing popularity as an approach to enhance sustainability.

This approach has at its core maximizing value for patients, moving from a supply-driven healthcare system towards a patient-centred system, organised around what patients need. To achieve high value, we must deliver the best possible outcomes in the most efficient way – outcomes that matter from the perspective of the individual receiving healthcare.

From my standpoint, however, this is only one piece of the puzzle. Indeed, the European Commission’s Expert Panel on Effective Ways of Investing in Health (EXPH) recognised that value has different meanings in its Opinion on Defining Value in “value-based healthcare”. It therefore formed 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)
• Contribution of healthcare to social participation and connectedness (societal value)

For regional authorities, allocative value is particularly important because it determines how equitably resources are distributed to different subgroups in the population (e.g., people with diabetes or people over 65 years old). When we decide to allocate resources, it is extremely important for public administrations to take into consideration the needs of patients first, but also to weigh up the benefits that we can achieve when allocating resources on a population subgroup basis.

Thus, besides the idea of technical value (outcomes/costs), regional authorities are focussing on allocative value, encouraging shared decision making, individual preferences for care, and ensuring that resources are allocated for maximum value at the population subgroup level.

Value-based healthcare provides a very useful set of tools with which to tackle some of the fundamental problems of sustainability in delivering high quality care. Above all, value-based healthcare is pushing public administrations to overcome a ‘siloed’ mentality in terms of policymaking and budgeting, shifting towards a multi-stakeholder dialogue.

There is, nonetheless, one clear point that we also stressed in our paper “Health in all Regions”. We cannot achieve these results alone. Without the positive dialogue and cooperation among the stakeholders from the civil society, academia and the industry it would be difficult to foster innovation and to rethink the whole health system. Reinforcing the multi-stakeholder partnerships, where appropriate and where additional value can be found, is thus the second fundamental step to foster the shift towards value-based healthcare.

We are then proud, as EUREGHA, to be part of the European Alliance for Value in Health (EAVH) and work with our partners. The EAVH will be not only a platform for knowledge exchange but, above all, a place where we can discuss actual implementation of value-based healthcare and foster the multi-stakeholder dialogue among our organisations and respective members. We are looking forward to implementing this change, ensuring that, in the future, all EU citizens can benefit from resilient and sustainable health and social care systems.

Valentina Polylas

Director at EUREGHA & Co-chair of the European Alliance for Value in Health