A value-based approach to healthcare is gradually gaining traction in Taiwan, as the country’s healthcare system confronts the opportunities and pressures of innovative new medical treatments along with a growing burden of both chronic and infectious diseases.

Any efforts to move Taiwan along in the process of establishing value measures will need to look at several key issues that have an impact on the future course of value-based healthcare: how the country’s healthcare decision-making institutions interpret value; who the main stakeholders with an input into the decision-making process are and should be; and what aspects of healthcare can logistically be evaluated within a value-based framework. In addition, experts say the health system will need to find ways to use its health technology assessment (HTA) capabilities to identify low-value areas where it is prudent to reduce investment in order to free up resources for more cost-effective expenditures. This process will require a more integrated use of HTA to evaluate not only medical treatments and devices, but entire care pathways.

European governments, like those in other parts of the world, are feeling the strain on their health budgets caused by an ageing population, a rise in the prevalence of chronic conditions and the acceleration of medical innovations that have increased demand for state-of-the-art treatment. As a result, governments are looking to make their money stretch further.

Traditionally, efficiency in healthcare has been interpreted largely in terms of cost reductions. More recently, healthcare policymakers in developed economies have interpreted the notion of value according to the willingness of health systems or individual health providers to follow best clinical practice. Increasingly, however, practitioners are promoting a more holistic, patient-centred understanding of value—one championed by the academics Michael Porter and Elizabeth Olmsted Teisberg, who first coined the term “value-based healthcare" [1] (VBH) to describe outcomes of health treatment relative to cost.

The effort to assess more accurately the value of healthcare investment has extensive implications for patient access, reimbursement of healthcare providers and health outcomes. Yet, the adoption of VBH assumptions in Europe has been piecemeal so far, with large variations in the extent to which European health systems measure patient outcomes, the ways in which they define value and the metrics that they use to do so. Equally, despite the demand for better access to healthcare innovations, the impact of public opinion on health policy varies across the continent.

Efforts to extend the use of VBH models in Europe have fallen short because of a lack of consensus so far about what performance indicators should be used, who to reward and how to quantify the value of incentives to motivate further efficiency. The absence of data on activity, cost and outcomes is particularly lacking in the area of ambulatory and primary-care-based interventions. A more extensive and standardised approach to VBH will require stronger evidence to support treatment and better co-ordination of care. 

[1] Porter, M. E., “What is Value in Health Care?”, The New England Journal of Medicine, 363:2477-2481, December 23rd 2010.

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Value-based healthcare looks at health outcomes of treatment relative to cost. In this particular report The EIU examines whether Japan's healthcare system delivers good value for money, its approach to pricing and reimbursement, and the evolution of a nascent system for health technology assessment (HTA).

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