Opportunities and Challenges of Value-Based Health Care: How Brazil Can Learn from U.S. Experience

Abstract

T he Brazilian Unified Health System (SUS) is one of the largest and most complex public health systems in the world and ensures comprehensive, universal access, and free health care for the entire population of Brazil. SUS provides universal access to the public health system without discrimination. Comprehensive health care has become a right for all Brazilians from pregnancy to the end of life, focusing on health with quality of life and aiming at prevention and health promotion. However, the SUS is not the only health care coverage option in Brazil. The private sector in Brazil currently covers 22.5% of the Brazilian population, yet this sector accounts for 57% of all health care spending in Brazil, including out-of-pocket expenses. Private health care is accessed either through employers or as supplemental insurance purchased by individuals.Private health plans are regulated by Agencia Nacional de Saude (ANS), a government agency, and are classified into several types, which comprise different forms of operation, such as health maintenance organizations, health insurers, selfinsured companies, philanthropies, and medical cooperatives. In November 2018, according to data from ANS, Brazil had 746 health plans, with 47.38 million beneficiaries. 1,2 The total health care expense in Brazil is approximately 8.2% of the gross domestic product: 4.4% is from private expenses, and 3.8% is

The implementation of value-based healthcare: a scoping review

“…In the non-empirical literature, the most frequently mentioned component was ‘measuring costs and outcomes for every patient’ ( N = 16)[ 51 – 57 , 59 , 60 , 62 , 65 , 67 , 69 – 72 ]. The second most often mentioned was ‘moving to bundled payments for the full cycle of care’ ( N = 7)[ 51 , 55 , 59 , 61 , 64 , 68 , 69 ]. Six articles described the component ‘organizing care into IPUs’ [ 52 , 55 , 56 , 58 , 66 , 69 ].…”

“…In 6 articles, the concept of VBHC was defined solely by reference to its value or its goals: three articles conceptualized only the value in VBHC [53][54][55] and three articles only the goals of VBHC [56][57][58]. The remaining fourteen articles did not conceptualize either the concept of VBHC, value, or goals [59][60][61][62][63][64][65][66][67][68][69][70][71][72].…”

Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

“…In Brazil, the predominant reimbursement model is the fee-for-service and, therefore, CMH may be used. 20 At our institution, a peculiar type of DRG reimbursement system, called Swiss-DRG, 5 is currently adopted and it shares many similarities to DRGs in other European countries and the United States. 21 , 22 , 23 That being said, even if reimbursements may have a slightly different CMH according to which healthcare systems is considered, results should remain comparable.…”