AMERICAS REGION — Case Studies ALIGNING VALUE
The country guarantees universal health coverage, but the system is highly fragmented
Brazil covers 150 million people through its Unified Health System (SUS), the world’s largest public health scheme. An additional 50 million Brazilians have private insurance plans and receive higher quality care. Although the country has established a health technology organization, there is no national policy to move toward patient-centered approaches or to organize health delivery in an integrated manner. Although registries are not linked, some healthcare institutions are starting to use electronic health records. However, Brazil has successfully implemented an integrated care model for HIV patients.
Specialisation and standardisation: Value-based healthcare at Canada’s Shouldice Hospital
Canada’s Shouldice Hospital specializes in hernia surgery and has achieved a lifetime success rate of 99.5% over the past 70 years, while offering treatments at approximately half the market price. The hospital has reduced surgical times and performs nearly 7,000 operations annually. The post-surgery care at Shouldice is designed to prevent patient readmission and offers two day stays following procedures for monitoring of potential complications and easily accessible rehabilitation. The hospital’s specialized care has produced excellent outcomes that are cost-effective.
Policymakers aim to expand basic value-based practices
Chile implemented health reforms in 2005 to target chronic diseases, which helped the country improve disease detection, reduce mortality and increase access to care. But a lack of sufficient data and a substandard information system have slowed the ability to produce accurate evaluations. Some measures for value-based care are emerging, such as risk-sharing schemes to cover the cost of expensive medications, and the involvement of private-sector partnerships. A proposal for a Health Technology Assessment agency has also been developed.
Colombia: Using technology to assess healthcare
Colombia’s overall movement toward a value-based healthcare model has resulted in lower national spending and shorter patient wait times. The country established a health technology assessment agency (IETS) in 2012 to strengthen public health policy formulation, and increase efficiency and sustainable equity within its healthcare system. Drawing from outcomes data, IETS provides recommendations on diagnostic tests, procedures and pharmaceuticals.
Putting value in place: America’s CMS Innovation Center
The Centers for Medicare and Medicaid Services (CMS) covers 100 million elderly or poor citizens. When the Affordable Care Act passed in 2010, the CMS Innovation Center was established to try new service and delivery models that would improve care and lower costs.