Adjusting contracts to the value provided by services

'Commissioning for value'bona iniciativa del NHS per identificar els millors programes d millora de la salut http://t.co/7whaXuF2d4
— Dr J Vidal-Alaball (@jvalaball) noviembre 22, 2013

Dr. Josep Vidal-Alaball is a family doctor trained in England and passionate about public and community health. He’s a keen Twitterer, very active in innovation.

The link in Dr. Vidal Alaball’s tweet, directs us to the English National Health Service’ website, named "Right Care", where it is stated that the purpose of the health system is to deliver more value to people’s health and, according to this statement, proposes that service contracts should be adjusted in-line with this value (Commissioning for value) and clarifies that the NHS adopts Michael Porter’s definition of value: clinical outcomes in relation to costs.

Heart failure: what works?

Heart failure is the end result of most heart diseases, especially ischemic coronary disease. This is a highly prevalent chronic condition among older people (6-10% in those over 65 years), which provides a great disease burden to the healthcare system.

Both for its origin, which is none other than the long-term failure of acute cardiac pathology, as well as for its diagnosis, the cardiologists, and not the family physicians are the ones leading the management of some clinical processes that are almost always torpid and uncertain and which require a lot of action in the community and a lot of coordination between the hospital and primary care; as you can see, it’s not an easy business.

Heart failure, unlike diabetes, is a chronic process that, as I have already mentioned, slips away from the hands of the family doctor. To begin with at the time of diagnosing, because the clinical diagnosis is only presumptive and sending the patient to the hospital for an echocardiogram confirmation is required. It now appears, however, that it has been shown that the "NT-proBNP*" test (Verdú 2012), detectable in both blood and urine testing is sufficiently cost-effective to be able to expect that primary care units could begin to autonomously solve the diagnosis.

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(*NT-proBNP. Natriuretic peptides are hormones with diuretic and vasodilator effects, segregated mainly in the left ventricle as a compensatory mechanism for a pressure overload).

Healthcare for diabetics: Is the Spanish model good enough?

Diabetes mellitus type 2 has a prevalence of 8% in the general population and 20% in over 65, and if you consider all the complications that arise, it is clear that this is a chronic disease that occurs most in everyday life of health systems. So, having the issue of diabetes well addressed is very important.

The Spanish model of primary health care included, since the beginning of its reform in the early 80s, a holistic model of diabetes care, with timely support from the endocrinologists and probably for this reason, the results recorded today are very satisfactory. See it in the OECD report of 2011, that when the rate of hospitalisations for admissions due to poorly controlled diabetes is analysed, Spain shows the lowest rate out of a group of 24 countries.

On the left side of the graph, where the accumulated data is, we can see that the admission of 3.3 per hundred thousand inhabitants and the year recorded in Spain represents half of the second country on the list, Israel, one-fifth of that of Portugal, one sixth of the U.S. and the UK, and so on, towards the worst performance in the series, which are those of Austria, with admissions of 187.9 per hundred thousand inhabitants a year.