The prices of services represent the basic element in the services procurement system, which is one of four elements within the financing arrangements of the health system. Three residual functions are as follows: raising funds, pooling of resources and the policy surrounding the definition of rights. Financing arrangements in a transparent and fair health system must be fair for providers and ensure that money follows a citizen, patient. It should facilitate high-quality treatment methods as well as promote optimum and rational use of all resources. Marc J. Roberts stated that “You get what you pay for! If you pay (in)efficacy, you will get (in)efficacy.”
The price should be proportionate to its costs and depend on the quality of services, patient satisfaction, standards of care and health outcomes. The fundamental and key part is certainly the price of its basic element – healthcare services. Yet there remains a question of which price is right. The right price mostly means the “cost price”, i.e. the price that reflects actual costs of healthcare services. This is certainly not the case. The cost price for individual cases in complex healthcare systems has been practically non-existent so far. This is due to the fact that even comparable healthcare services are so complex and performed to the detail in so many different ways, with different materials, executed by different teams in different work spaces and with different equipment… That is why it is absurd and unproductive to calculate costs or “the right price”. The price differs on a case-by-case basis, also when it comes to substantively completely comparable cases. This basically does not merely apply to healthcare, but to virtually all complex systems, also to the economy. It is thus the objective within healthcare systems to arrive at the price that would make it possible to achieve what I have stated in my previous response.
The calculation of the right price is the primary task of the payer coupled with the necessary involvement of medical and economic experts. In addition to the knowledge of cost analysis methods, they should also be familiar with health technology valuation methods. The system controller (or regulator) should merely put in place strategic incentives. When calculating the prices of healthcare services, one of the following three methods is mostly used: analysis of actual costs, standard cost determination or ratios of price to cost (weights) in another country which has already set standard prices. The payer, service provider and regulator seek the combination of all three above-mentioned approaches. The most elaborated financing arrangements use the payment for stationary-hospital treatment outcomes (SPP, DRG, case mix), which has become the standard method for payment. When introducing the system, most countries initially opt for the transfer of ratios of price to cost from another country and then within five (preferably three) years at the latest put in place their own relative prices based on their cost analysis. The system would degenerate otherwise.
The demonstration of under/excessive funding by setting “the right” price of healthcare services is certainly not the right way to go. The right way should start by setting real health needs of citizens, to be followed by politics that comprehends this. The issue of financing, even less the price of services themselves, is not the key issue of the health system. Funding should follow the demographic structure of the population, their rights and needs as well as the organisation of the system. Underfunding is a relative and misleading concept since a suboptimally organised healthcare system will always be underfunded, which is correct since it has to lead to the streamlining and optimization of the system.
The starting point should be the healthcare basket. In doing so, it should be considered that the healthcare system network, which consists of providers, their capacities as well as the number and quality of all provided services and prescribed treatment methods, is substantively also part of the basic healthcare basket. Reorganization should be performed on the basis of professional processes, clinical pathways and guidelines. This can lead to contraction in micro-environments, yet to global expansion in the medium and macro-environment – consequently giving rise to improvement. By determining national priorities and by using valuation methods for healthcare services, it is easy to calculate the requisite amount of additional funds, if any.
A lack of resources was a permanent feature in all countries over the past years of the economic crisis. Numerous studies looked into ways and means to find reserves and additional resources within health systems. Slovenia also employed its own measures (price cuts, broadening of bases, increase of contribution rates) that were perhaps not most aptly chosen, to say the least. The regulator will have to conduct the analysis of implemented measures by considering the impact on citizens’ health.
Since healthcare – as any other system – is not ideal, there will always be at least one additional path. Building on our experience in this millennium, we can agree that the search has not been the most fruitful. Therefore, key issues should be addressed first. When seeking solutions to all the key issues in healthcare, we could certainly begin by placing citizens instead of patients at the centre!