Healthcare has made fantastic advances in the last fifty years through scientific developments such as the artificial hip, chemotherapy, stents and MRI. It has also improve decision making and delivery through a number of paradigm shifts but every country committed to universal healthcare is facing a huge challenge. Need and demand are increasing faster than resources. What is emerging is a new paradigm which will, like all paradigm shifts, enfold the previous paradigms which remain of vital importance. But, it is now clear that to increase the number of interventions of proven cost effectiveness, even if delivered at high quality with efficiently, will not close the gap. The new paradigm is value based healthcare.
The EU Expert Panel’s Report defines four aspects of value:
personal value - appropriate care to achieve a patient’s personal goals
allocative value - equitable resource distribution across all populations and within each population across all patient groups
technical value - achievement of best possible outcomes with the resources available for all the people in need
social value - contribution of healthcare to social participation and connectedness
But how will this be brought about? Not by yet another bureaucratic reorganisation, nor by privatisation. As Oliver Williamson, joint winner of the Nobel Prize for Economic Science in 2009, emphasised challenges like healthcare are too complex for bureaucracies and markets alone or together, they need systems and networks. And, as Manuel Castells has emphasised this is the century of the system and the network.
“The concept of the network society shifts the emphasis to organizational transformation, and to the emergence of a globally interdependent social structure, with its process of domination and counter-domination. It also helps us to define the terms of the fundamental dilemma of our world: the dominance of the programs of a global network of power without social control or, alternatively, the emergence of a network of interacting cultures, unified by a common belief in the use value of sharing.”
Castells, M. (2004) The Network Society. A Cross-cultural perspective. Edward Elgar Publishing Ltd. (p 42-43).
We need a single system specification for each of the population segments, for people with Type 1 diabetes or people with back pain or people in the last year of life, for example. These need to be delivered by local networks focused on and accountable to a defined population.
There is also a need for a new culture - the culture of stewardship, described by Elinor Ostrom, the joint winner of the Nobel Prize.
But, again, how will this be brought about? Not by Government decree or the creation of a new bureaucracy but by a national network for Spain, the Red de Valor. Muir Gray and Julio Mayol will start the process of reticulation by inviting all the individuals and organisations who came to the III Congreso Internacional de Gestion Sanitaria, held in Madrid on the 16th and 17th of June 2022 to join the network.
The EU Expert Panel’s Report defines four aspects of value:
personal value - appropriate care to achieve a patient’s personal goals
allocative value - equitable resource distribution across all populations and within each population across all patient groups
technical value - achievement of best possible outcomes with the resources available for all the people in need
social value - contribution of healthcare to social participation and connectedness
But how will this be brought about? Not by yet another bureaucratic reorganisation, nor by privatisation. As Oliver Williamson, joint winner of the Nobel Prize for Economic Science in 2009, emphasised challenges like healthcare are too complex for bureaucracies and markets alone or together, they need systems and networks. And, as Manuel Castells has emphasised this is the century of the system and the network.
“The concept of the network society shifts the emphasis to organizational transformation, and to the emergence of a globally interdependent social structure, with its process of domination and counter-domination. It also helps us to define the terms of the fundamental dilemma of our world: the dominance of the programs of a global network of power without social control or, alternatively, the emergence of a network of interacting cultures, unified by a common belief in the use value of sharing.”
Castells, M. (2004) The Network Society. A Cross-cultural perspective. Edward Elgar Publishing Ltd. (p 42-43).
We need a single system specification for each of the population segments, for people with Type 1 diabetes or people with back pain or people in the last year of life, for example. These need to be delivered by local networks focused on and accountable to a defined population.
There is also a need for a new culture - the culture of stewardship, described by Elinor Ostrom, the joint winner of the Nobel Prize.
But, again, how will this be brought about? Not by Government decree or the creation of a new bureaucracy but by a national network for Spain, the Red de Valor. Muir Gray and Julio Mayol will start the process of reticulation by inviting all the individuals and organisations who came to the III Congreso Internacional de Gestion Sanitaria, held in Madrid on the 16th and 17th of June 2022 to join the network.
