Using value-based health care principles to "fix" orthopaedic care delivery

Bernstein, D.N. (2023)

Doctoral Thesis

Despite differences in the structure of health care delivery systems, health care spending continues to outpace gross domestic product (GDP) and average wage globally. This highlights the stark reality that health systems today are – in many cases – financially unsustainable. Further, most health care services today are paid for via a fee-for-service or payment for each service provided mechanism, which does not ensure a focus on optimal health outcomes for patients; this includes clinical outcomes most important to them, such as function, pain, and
quality of life. As such, bold reforms are needed to better align incentives to “bend” the cost curve and to ensure high-quality health care and the best possible patient outcomes.

This dissertation includes scientific studies that highlight how the core principles of value-based health care, which focuses on maximizing the outcomes achieved per dollar spent, may be able to begin to address some of the issues plaguing our strained health care delivery systems globally, including within orthopaedic surgery.

• Value-based health care
• Patient-reported outcome measures
• PROMs
• PROMIS
• Time-driven activity-based costing
• TDABC
• Orthopaedic surgery
• Bundled payment
• Health disparities
• Health care transformation

• All authors: Bernstein, D.N.
• Supervisor: Poolman, R.W.; Baumhauer, J.F.
• Committee: Nelissen, R.G.H.H.; Biesma, D.H.; Bos, W.J.W.; Terwee, C.B.; Mesfin, A.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2023-11-09
• ISBN (print): 9789464833997