Analysis of stakeholder views on value-based health services

It is seen that some pioneering studies have been carried out on the value phenomenon in health services within the Turkish health system. However, it can be stated that these studies have not reached the desired level yet. Value-based health services play an essential role in achieving the desired level. It is seen that this approach has become a necessity globally with the transition of many countries in the world to this system and the studies carried out. This approach relates to health outcomes and costs and considers the consequences for every money spent. However, it is seen that there is no consensus in the literature regarding value-based health services. For this reason, a literature analysis was first carried out in the study. Afterwards, it was tried to determine the opinions of the stakeholders in the Turkish health system were on the subject. National and international studies carried out between 2008 and 2018 were included in the literature analysis. As a result of this analysis, 169 academic studies were examined, and answers were sought to the questions of how value-based health services are defined, why they are necessary, how to do it, who the stakeholders are, and how they are measured. However, as a result of the analysis, different answers were given to each question; In fact, it has been determined that the answers to these questions may vary according to the country and time of application. Then, within the scope of the study, the answers to the above questions in the Turkish health system were obtained from health service providers, health politicians, and third-party payers. The possibility of looking at the phenomenon from different perspectives was influential in the preference of these three stakeholder groups, as they play different roles. The study was designed as a basic qualitative research in order to examine the stakeholder views more comprehensively. In the study, an in-depth interview method was used for data collection. Interviews with stakeholders were conducted between November 2020 and March 2021. In-depth interviews were conducted with 19 people; 7 with health service providers, 5 with third-party payers, and 7 with health politicians. A semi-structured interview form, which was created using the literature, was used as a data collection tool in the interviews. All interviews were recorded (audio or video). The total recording time is 1247 minutes. Audio and video recordings were first transferred to the Word environment and then subjected to content analysis with the Nvivo 12 program. Research findings were explicitly evaluated for each research question, and separate categories and themes were determined. A total of 21 themes were formed within the scope of the research. Three of these themes were associated with the question of what is value-based health care. The themes that emerged from this question were integration, health outcomes, and cost reduction. Five themes emerged regarding why value-based health services are needed, and the themes are; instant solutions, health service delivery problems, rising costs, lack of holistic view, and sustainability. The following research question is related to how value-based health services can be realized within the Turkish health system. Five themes emerged regarding this question. These themes are monitoring and prevention, new system design, integrated implementation units, healthcare utilization culture, and supporting institutions. A total of two themes were determined regarding how the value-based health services to be created will be measured. These themes are related to health outcomes and health care costs as well as definitions. Finally, the themes of value-based health care stakeholders, service providers, politicians, medical associations, Social Security Institution, health technologies evaluation, and private health insurance establishments were determined. Concerning the themes and categories, the densities of the participants differ. In addition, the identified themes show similarities and differences with the literature. The reason for the differences is that each health system has its characteristics. This study contributes to the review of the studies in the literature as a whole. Although it is not directly among the policies of the Ministry of Health, it is thought that it will help make health more valuable and understand how it can bring health. Finally, the stakeholders should gather around a common goal and action plans should be prepared to adapt the phenomenon to the Turkish health system. In this way, existing problems will be solved and the system will become more valuable for all stakeholders.