J Korean Med Sci.  2022 Apr;37(15):e111. 10.3346/jkms.2022.37.e111.

Hospice-Palliative Medicine as a Model of Value-Based Healthcare

Affiliations
  • 1Patient-Centered Clinical Research Coordinating Center, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
  • 2Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
  • 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

Abstract

Advances in medical technology have increased people’s lifespans, and evidence-based medicine that utilizes health technology assessments has contributed significantly to medical development. Owing to the ever-increasing costs of medical services, cost-effectiveness analysis has been adopted to ensure the efficient use of limited healthcare resources. However, problems that cannot be solved through medical technology alone have emerged because of the aging of the global population. When faced with a choice providing lifesustaining treatment to a terminally ill patient or offering them comfortable end-of-life care in a hospice, value-based choice takes precedence over technical judgment. In addition to cost, various values must be considered when making medical decisions. The World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD) expect “value-based healthcare” (VBHC) to play a major role in solving these problems. 1 However, the concept itself remains vague and has not attracted significant attention in the field of medicine.


Figure

  • Fig. 1 Changes over time in the place of death of Koreans (plots based on Statistics Korea, Feb 26, 2020).


Reference

1. WHO. From value for money to value-based health services: a twenty-first-century shift. Updated 2021. Accessed February 14, 2022. https://www.who.int/choice/publications/vbhs.pdf?ua=1 .
2. Hurst L, Mahtani K, Pluddemann A, Lewis S, Harvey K, Briggs A, et al. Defining value-based healthcare in the NHS. Updated 2019. Accessed February 14, 2022. https://www.cebm.net/wp-content/uploads/2019/04/Defining-Value-based-healthcare-in-the-NHS_201904.pdf .
3. European Commission. Defining value in ‘value-based healthcare’. Updated 2021. Accessed February 14, 2022. https://www.europeanallianceforvalueinhealth.eu/publication/defining-value-in-value-based-healthcare/ .
4. Institute of Medicine 2013. Delivering high-quality cancer care: charting a new course for a system in crisis. Washington, DC: The National Academies Press;2013.
5. Keating NL, Jhatakia S, Brooks GA, Tripp AS, Cintina I, Landrum MB, et al. Association of participation in the oncology care model with medicare payments, utilization, care delivery, and quality outcomes. JAMA. 2021; 326(18):1829–1839. PMID: 34751709.
6. Checkland K, Coleman A, Croke S, Billings J, Mikelyte R, Macinnes J, et al. National evaluation of the Vanguard new care models programme. Updated 2021. Accessed February 14, 2022. https://prucomm.ac.uk/assets/uploads/NCM_qualitative_case_study_report.pdf .
7. Jivraj A, Barrow J, Listl S. Value-based oral health care: implementation lessons from four case studies. J Evid Based Dent Pract. 2022; 22(1S):101662. PMID: 35063180.
8. Sampaio SGDSM, Motta LBD, Caldas CP. Value-based medicine and palliative care: how do they converge? Expert Rev Pharmacoecon Outcomes Res. 2019; 19(5):509–515. PMID: 31370715.
9. Oh DY, Kim JE, Lee CH, Lim JS, Jung KH, Heo DS, et al. Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies. Cancer. 2004; 100(9):1961–1966. PMID: 15112278.
10. Jung HM, Kim J, Heo DS, Baek SK. Health economics of a palliative care unit for terminal cancer patients: a retrospective cohort study. Support Care Cancer. 2012; 20(1):29–37. PMID: 21110045.
11. OECD Data. Pharmaceutical spending. Updated 2021. Accessed February 14, 2022. https://data.oecd.org/healthres/pharmaceutical-spending.htm .
12. Statistics Korea. 2020 birth and death statistics provisional results. Updated 2020. Accessed February 14, 2022. https://www.kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=380865 .
13. Dailymedi. The desired place of death is home, but most deaths occur in hospitals. Updated 2016. Accessed February 14, 2022. http://dailymedi.com/detail.php?number=809216&thread=22r01 .
14. Lee HY, Kim HJ, Kwon JH, Baek SK, Won YW, Kim YJ, et al. The situation of life-sustaining treatment one year after enforcement of the act on decisions on life-sustaining treatment for patients at the end-of-life in Korea: data of national agency for management of life-sustaining treatment. Cancer Res Treat. 2021; 53(4):897–907. PMID: 34082496.
15. Kim D, Lee HJ, Yu SY, Kwon JH, Ahn HK, Kim JH, et al. Awareness of doctors’ shared decision-making in life-sustaining care decisions. J Hosp Palliat Care. 2021; 24(4):204–213.
16. Peile E. Evidence-based medicine and values-based medicine: partners in clinical education as well as in clinical practice. BMC Med. 2013; 11:40. PMID: 23414247.
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