At an event hosted by Gregory Katz and Raquel Correia at Université Paris Cité earlier this year, I spoke about one of healthcare’s most complex and controversial topics: how we pay for value.
Too often, discussions about value-based financing become focused on how individual physicians are paid, particularly within insurance-based systems moving away from fee-for-service models. While this debate is important, I believe it risks missing the bigger picture.
Patient outcomes are rarely determined by a single clinician alone. Paying individual doctors based on outcomes can therefore be problematic. More importantly, reducing value-based financing to a conversation about individual remuneration overlooks the broader financial levers required to improve outcomes and make best use of resources across healthcare systems.
A useful starting point is to step back and ask what we are trying to achieve. Do we want better outcomes, delivered equitably, for our populations? Do we want to manage rising costs and make best use of available resources? If we agree on these goals, then we are ultimately seeking value in health.
During the conference, delegates discussed a wide range of challenges that require investment if we are to achieve better outcomes. These included reducing unwarranted variation in surgical pathways, supporting patients to co-manage chronic disease, funding innovative medicines, enabling digital health solutions, and improving population health while ensuring nobody is left behind.
What became clear is that context matters. Different challenges require different approaches, and there is no single payment model that will work in every situation.
I concluded this part of the discussion with three truths about paying for value:
- We get what we pay for.
- Financial levers are fundamentally about influencing behaviour.
- Whatever we do, unintended consequences will always occur.
These principles provide an important foundation for any conversation about financing healthcare for better outcomes.