Designing a value-based payment system for hospitals in Iran

Abstract

Designing a Value based purchasing system for hospitals in Iran Abstract Introduction: Value-based payment represents an innovative payment system that rewards healthcare services based on their quality. The evolution of value-based payment in health systems across countries reflects a shift from volume-based care to value-based care. With rising healthcare costs and increased focus on patient outcomes, this payment method has become an important topic in health management. Objective: The present study was conducted to design a value-based payment model in the hospitals of Iran. Methodology and Materials: The current research is a mixed-method study that was conducted in three stages. In the first stage, the domains, indicators, and factors affecting value-based purchasing were identified using a systematic review of texts. The second stage aimed to identify the challenges of hospital payment systems using face-to-face interviews and focused group discussions, which were then summarized using content analysis. In the third stage, the indicators and domains of value-based payment were weighted and prioritized using the Analytic Hierarchy Process (AHP). Finally, the framework of the model was designed based on the results of the previous stages and its validity was examined using the Delphi method. Results: The results of the study indicate that the domains of safety, clinical outcomes, clinical processes of care and support, effectiveness and efficiency, and patient and community participation are of high value. Hence value-based payment should be based on the measures derived from these domains. A total of 30 measures were identified as having high priority and weight, which were included in the framework of the model. Conclusions: Designing a value-based payment model has a complex and multidimensional nature, and its implementation requires strong hospital infrastructure, a credible data registration system, and realistic tariffs. Therefore, it is recommended that policymakers pay attention to these challenges before making any changes. However, numerous studies demonstrate the effectiveness of value-based payment models in influencing the behavior of service providers towards improving quality and commitment to patient outcomes. Keywords: Value, hospital, payment system, Iran