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Medical Students’ Awareness About Value-Based Health Care in Brazil: A Cross Sectional Study

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DOI:

https://doi.org/10.5195/ijms.2022.1253

Keywords:

Delivery of Health Care, Health Care Costs, Medical Students, Brazil

Abstract

Background: Rising healthcare costs demand a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. This requires that all future doctors to understand the VBHC Model. We aimed to evaluate the VBHC awareness among Brazilian medical students and to identify it’s associated intrinsic/extrinsic factors through a survey-based, cross-sectional study.

Methods: An online survey was sent to students from Brazilian medical schools. A descriptive analysis based on participants' level of awareness about VBHC was performed. The categorical variables included were absolute and relative frequencies using chi-square tests. A multivariate binary logistic regression analysis was performed by calculating the odds ratio (OR) and 95% confidence intervals (95%CI) to compare each response according to VBHC awareness.

Results: We collected 3030 responses from 148 Medical Schools across all Brazilian states. Medical students were compared into 2 groups; 1 was familiar with VBHC (14%; 426); 2 were not (86%; 2575). The univariate analysis showed that group 1 was more willing to share clinical outcomes/costs data related to their practice (57.04%) compared to 2 (48.12%), p<0.01. The multivariate analysis showed that internship experience was the most relevant factor associated with VBHC exposure (OR 4.32 [CI 95% 1.82 - 10.24]).

Conclusion: We found that few medical students understand VBHC concepts, and that exposure was due to self-education efforts. Our results suggest that medical schools have the potential to reinforce both intrinsic and extrinsic factors related to students with regards to VBHC knowledge in order to prepare future doctors to practice in a value-driven context.

References

World Health Organization. World Health Organization Global Health Expenditure database. Available from: http://apps.who.int/nha/database; Last updated 2022 Jan 22; cited 2021 Aug 16.

Lee VS, Kawamoto K, Hess R, Park C, Young J, Hunter C, et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA. 2016;316(10):1061-72.

Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston, MA: Harvard Business Press; 2006.

Porter ME, Lee TH. The strategy that will fix health care. Har Bus Rev. 2013;91:1-19.

Katz M, Franken, M, Makdisse M. Value-based health care in Latin America: an urgent discussion. J Am Coll Cardiol. 2017;70:904-6.

Makdisse M, Katz M, Ramos P, Pereira A, Shiramizo S, Neto M, Klajner S. What is a value management office? An implementation experience in Latin America. Value Health Reg Issues. 2018;17:71-3.

Moriates C, Wong BM. High-value care programmes from the bottom-up... and the top-down. BMJ Qual Saf. 2016;25:821-3.

Moriates C, Dohan D, Spetz J, Sawaya GF. Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative. Acad Med. 2015;90:421-4.

Fredriksson JJ, Ebbevi D, Savage C. Pseudo-understanding: an analysis of the dilution of value in healthcare. BMJ Qual Saf. 2015;24:451-7.

Makdisse M, Ramos P, Malheiro D, Felix M,, Cypriano A, Soares J, et al. What do doctors think about value-based healthcare? A survey of practicing physicians in a private healthcare provider in Brazil. Value Health Reg Issues: 2020;23:25-9.

Gupta R, Moriates C, Harrison JD, Valencia V, Ong M, Clarke R, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation. BMJ Qual Saf. 2017;26:475-83.

Gonzalo JD, Haidet P, Blatt B, Wolpaw D. Identifying challenges in implementing systems-based curriculum: A qualitative assessment of medical student perspectives. In: National Society of General Internal Medicine Conference 2015 Apr 23.

Geraghty JR, Young AN, Berkel TDM, Wallbruch E, Mann J, Park YS, et al. Empowering medical students as agents of curricular change: a value-added approach to student engagement in medical education. Perspect Med Educ. 2020;9(1):60-5.

Moriates C, Valencia V, Stamets S, Joo J, MacClements J, Wilkerson LA, et al. Using interactive learning modules to teach value-based health care to health professions trainees across the United States. Acad Med. 2019;94(9):1332-6.

Starr SR, Agrwal N, Bryan MJ, Buhrman Y, Gilbert J, Huber JM, et al. Science of Health Care Delivery. An Innovation in Undergraduate Medical Education to Meet Society's Needs. Mayo Clin Proc Innov Qual Outcomes. 2017;1(2):117–29.

Holtzman JN, Deshpande BR, Stuart JC, Feeley TW, Witkowski M, Hundert EM, et al. Value-based health care in undergraduate medical education. Acad Med. 2020;95(5):740-3.

Published

2022-04-25 — Updated on 2022-06-30

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Hirt, G. ., Gushken, F., Borges Gomes da Silva, G., Lacerda Heringer, D. ., Castro Gomes de Mello, L. ., Tavares Malheiro, D. ., & Makdisse, M. . (2022). Medical Students’ Awareness About Value-Based Health Care in Brazil: A Cross Sectional Study. International Journal of Medical Students, 10(2), 129–138. https://doi.org/10.5195/ijms.2022.1253

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