Pay less and spend more—the real value in healthcare procurement

Abstract

Healthcare performances have been for long evaluated according to outcomes and costs.What still needs to be defined is which outcomes are the most relevant to the patient, and which costs any supplier is capable to reduce, or increase, to the funder. If technical efficiencies during healthcare production and delivery may continue to evolve, the opportunities for further savings are likely to decrease. Major improvement could be achieved from better definition of outcomes that really matters to patients and stakeholders, that is measuring the real value. Many purchasers are shifting from a traditional approach based on single-unit cost-saving to a more holistic approach, encompassing longlasting performance evaluation, including the highest possible number of stakeholders and wider sets of indicators. Value-based procurement (VBP) has been defined as achieving "outcomes that matter to people at the lowest possible cost". Although this approach may appear complicated in practice, it was already proven successful in different countries, medical and surgical applications, and has also been endorsed by some important international institutions. The scope of this review is to introduce VBP from a theoretical and an empirical level, referring to relevant practices and challenges which emerged in the current institutional, clinical and academic debate. VBP seems to be a promising solution to improve healthcare efficiency and fairness, provided a clear conception of what is value and a permanent collaboration between clinicians and scientists. When different dimensions of value (i.e., personal, technical, allocative and societal) are supported by well-designed study to identify the respective outcomes, it becomes easier to find better solutions in support of healthcare quality and sustainability.

Reporting and utilization of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures in orthopedic research and practice: a systematic review

“…Our findings are relevant for orthopedic researchers and clinicians who are using, or considering using, PROMIS measures. Our findings can provide guidance for stakeholders about the selection and administration of PRO measures, supporting value-based decisions both in clinics and prostheses procurement [ 110 ]. The domains of physical function and pain interference are the most commonly reported PROMIS domains, and these measure similar constructs to the traditional, body region-specific measures.…”

Value-Based procurement for medical devices: A scoping review

“…VBP is a decision-making methodology that improves the quality and outcomes of purchasing decisions while maintaining cost control ( 11 , 23 ) and it is possible through setting clinical requirements, cost reduction expectations, and innovation opportunities ( 4 , 14 ). With these definitions, Krantz seems to have provided the most comprehensive definition: “making deliberate choices on what products and services are needed to provide best-in-class care at an affordable cost through a framework that guide the review and decision-making processes by analyzing the cost and clinical outcomes expected from the use of that product or equipment in the care of patients.” ( 24 ) The results of analysis of selected articles in understanding the definition of VBP in medical devices are shown in Table 3 .…”

“…In addition to not considering other factors in the procurement of medical equipment, there is diversity in the procurement process between countries as well as within a country ( 9 ). These limitations in the medical device procurement can be seen in the inadequate information system, conflicting incentives, fragmented organizing in procurers, and disqualification of procurers to seek more value ( 6 , 10 , 11 ).…”

“…Studies have shown that a shift to a value-based approach in medical equipment procurement can lead to better health and greater cost-effectiveness in hospital ( 5 , 9 , 12 , 16 ). Besides, this approach would be also useful for identifying opportunities for innovation ( 11 ). A report showed that some of European countries are moving towards value-based procurement (VBP), albeit at different speeds ( 17 ).…”

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

“…In addition, uniform HDF reporting must be supported by validated national guidelines to reduce the variety in compliance. Given the high socioeconomic impact of musculoskeletal infections [52], of which prosthetic joint infections are of particular concern [33], reducing device-related preventable infections is a key element for delivering value-based healthcare in terms of personal value (improved safety and patient-centred care), technical value (improved quality of care and device purchasing), allocative value (increased cost-effectiveness and reduced readmissions in the long term) and social value (reduced human and economic burden to society) [53,54].…”