Cost variability in medical treatments: A value-based healthcare perspective

Abstract

This comprehensive thesis is dedicated to the crucial topic of cost transparency within the healthcare sector, with a primary focus on its significance in achieving the goals of value-based healthcare (VBHC). The research is structured into five studies, each addressing specific research objectives and significantly contributing to healthcare management. Paper 1 conducts an extensive systematic literature review that delves into the complex cost variability in healthcare settings. This review identifies and categorizes various cost drivers across different medical domains. It presents a comprehensive overview of the factors contributing to cost variations and offers valuable recommendations for future research regarding variables to investigate and methodologies to employ. This chapter significantly enhances our understanding of the intricacies of cost variability in healthcare, paving the way for more informed decisions and practices. Paper 2 takes a deep dive into early-stage invasive breast cancer treatment costs. Employing the innovative approach of time-driven activity-based costing (TD-ABC), this chapter aims to unravel the specific drivers of cost variability within this medical domain. By analyzing factors such as patient characteristics and disease severity, this research provides essential insights into the dynamics of treatment cost determinants. These findings are critical for optimizing care delivery and resource allocation. Paper 3 narrows its scope to the field of dermatology care, specifically concentrating on the consultation component of psoriasis treatment. Utilizing TD-ABC, this chapter identifies and explores key cost drivers, including patient status, personality type, and therapy switches. The empirical analysis sheds light on the factors contributing to cost variability and offers actionable recommendations for process improvements within dermatology departments. Paper 4 builds upon the foundational research initiated in Paper 2, specifically focusing on the luminal B molecular subtype of breast cancer. This chapter uses statistical analysis to examine a broader dataset, providing insights into the cost drivers for the entire treatment cycle and the surgical intervention within this treatment pathway. These findings are essential for optimizing care and exploring potential applications of bundled payments in the context of breast cancer treatment. Paper 5 focuses on bundled payments, a prominent reimbursement approach within VBHC. This chapter conducts a scoping literature review to compare the existing body of research on bundled payments with the theoretical framework proposed by Porter and Kaplan. This analysis uncovers significant gaps and challenges in implementing bundled payments, highlighting the need for further exploration and standardization. In summary, this thesis comprehensively explores cost transparency in healthcare and its implications for achieving value-based healthcare. By systematically addressing critical gaps in the existing literature and providing practical insights, this research seeks to empower healthcare providers and policymakers to enhance the efficiency and value of healthcare delivery, ultimately benefitting patients and the entire healthcare ecosystem.