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Table of Contents
Year : 2014  |  Volume : 8  |  Issue : 1  |  Page : 41-45

Value based care

1 Clinical Instructor, College of Nursing, NIMHANS, Bengaluru, India
2 Former Additional Proffessor, Dept. of Nursing, NIMHANS, Bengaluru, India

Date of Web Publication8-Jul-2019

Correspondence Address:
G Jothimani
Clinical Instructor, College of Nursing, NIMHANS, Bengaluru
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.262278

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How to cite this article:
Jothimani G, Nagarajaiah. Value based care. Indian J Psy Nsg 2014;8:41-5

How to cite this URL:
Jothimani G, Nagarajaiah. Value based care. Indian J Psy Nsg [serial online] 2014 [cited 2022 Aug 20];8:41-5. Available from: https://www.ijpn.in/text.asp?2014/8/1/41/262278

  Introduction Top

Value based care deals with specific issues that surround special populations in a value-based care system. The population will include, but are not limited to, elderly, children, persons with disabilities, and persons with behavioral health care needs. Significant improvement in value will require fundamental restructuring of health care delivery, care pathways, safety initiatives, case managers, disease management. Value-based health care is a health care management strategy focusing on costs, quality and, most importantly, outcomes.[1]

It is essential for vulnerable people, those who are susceptible to harm. It also results from developmental problems, personal incapacities, disadvantaged social status, inadequacy of interpersonal networks and supports, degraded neighborhoods and environments, and the complex interactions of these factors over the life course. The value based care also provides set of rules or regulations and guidelines that every care practitioner has to follow in order to provide service to their clients or patients.[1]

Importance of value based care

1. Care

Human care is recognizable and structured interaction in human societies through which persons give and receive assistance with basic human needs, in wellness and illness across the life span, before birth, throughout life and beyond death.

2. Importance

The value based care is important because many laws now prohibit discrimination on the grounds of race, religion, gender, sexual orientation, age or disability.

Any violation of the value based care may result in dismissals, lawsuits, and, in a case of an entire institution acting unethically, enforced closure. The value based care also helps the clients promote their rights by outlining what they expect from health care services.[1],[2]

Principles of value based care

The value based care offers guidance, and sets standards, in three main areas of health and social care: Fostering (which means supporting and encouraging) equality and diversity, Fostering people’s rights and responsibilities, Maintaining confidentiality of information. It has the following principles.

The seven principles are [2],[3]

  1. Promoting anti-discriminatory practice
  2. Maintaining confidentiality of information
  3. Promoting and supporting individual’s right to dignity, independence, choice and safety
  4. Acknowledging people’s personal beliefs and identities
  5. Protecting individuals from abuse
  6. Providing effective communication and relationships
  7. Providing individualized care

1. Discrimination- is the result of stereotyping and prejudice. It means providing worse (or better) care to some people because they are of a particular group, like Asian people, lesbians and gays, older people and so on. Here are some of the most common.

• Race Discrimination- treating someone differently because of the color of their skin or their racial background. For example, care workers may spend time chatting to someone from their own racial background, but ignore clients they see as ‘foreigners’

• Sex Discrimination- treating someone differently because they are male or female. For example, medical staff may explain things in more detail to a man than to a woman.

• Age Discrimination- means being treated less favorably because of your age. For example, someone may be refused certain treatments or operations because they are thought to be too old to make it worthwhile.

• Disability Discrimination- being treated less favorably because of a disability. For example, wheelchair users may have difficulty gaining access to a health centre that does not have electric doors.

2. Confidentiality of information-This means that any information clients gives to care givers is private and confidential, whether it is: Verbal, Written, Electronic (on a computer), we need to be aware of what we say to other care givers and clients and also who has access to client files.[2]

3. Promoting and supporting individual’s right to dignity, independence, choice and safety-As a caregiver working with clients face to face, we can do a lot to ensure that a client’s background or circumstances do not affect the quality of care they receive. This doesn’t mean treating everyone the same.

4. Acknowledging people’s personal beliefs and identities-treating each person as an individual, taking into account their beliefs, abilities, likes and dislikes. This is known as client-centered care.

5. Protecting individuals from abuse and prejudice- means liking or disliking someone not because of who they are, but because of how they feel about their lifestyle or background. Care givers have a responsibility to ensure that prejudice doesn’t affect the quality of care given to clients.

6. Providing effective communication and relationships-Communication and interpersonal skills are essential components in delivering good quality nursing care. Communication is identified as one of the essential skills that care givers must acquire in order to make progress through their profession. It helps to identify and provide good value based care to the clients.

7. Providing individualized care - supporting a client’s right to choose their own lifestyle and helping them to accept their responsibilities. So the client has the right to eat healthy food, but we need to tell them about the health risks, so they can take responsibility for their choice.[2],[3]

People who are in need for value based care

  • Uninsured
  • Homeless
  • Elderly and frail
  • Suffering from a range of chronic diseases
  • Children

For example

1. Elderly

Older adults were at increased risk for errors during and after the transition from hospital discharge to home. Care coordination has demonstrated improved outcomes and cost savings for patients transitioning from acute care hospitals to the home, especially for the frail, elderly population.

2. Children

Care coordination is especially important and challenging for children who have complex chronic conditions that may be lifelong and require special services. Even more challenging is coordinating care across systems for children with special health care needs, from primary care to specialty care (often called tertiary care). Gordon, et al. (2007) used three years of longitudinal data to examine the care of 230 children with complex illnesses who were enrolled in a dedicated program for children with special health care needs. Pediatric nurse case managers served as single points of contact for the families and providers.[3]

Need for value based care

  • The value based care is very essential for the groups those have AIDS epidemic, welfare reform, person with disabilities, homelessness, concerns about terrorism and preparation for chemical and biological attack, and increasing worry about the viability of public health systems.
  • Early-life difficulties and their adverse effects interact with later events in ways that increase the likelihood of poor adult outcomes.
  • The welfare of adolescents, young adults, and the elderly depends greatly on trajectories of personal development, social and economic experiences of one’s family and community, and stressors that may be unique to various age groups or to communities at a particular time.
  • Poor socioeconomic status (SES), for example, is linked to deficiencies in prenatal and early nutrition.[4]

Value Based Care -A unifying focus

Population is usually treated similarly to notions of need, risk, susceptibility to harm or neglect, or lacking durability or capability. For example, identified relative special group among people (by age, sex, and race/ethnicity), within interpersonal relationships (by family structure, marital status, and social networks), and by access to neighborhood resources (such as schools, jobs, income, and housing).

1. Interaction of Moral Values and Politics in Setting Policy Priorities

At any given time, the attention to particular populations or problems depends heavily on politics and views about morality. For example, Morone notes that “the personal transgressions—the sins that endanger the nation are most often public health sins.” The list of issues seen differently from public health and moral perspectives includes medical marijuana, the war on drugs and imprisonment, alcohol abuse, premarital sex and pregnancy, birth control and abortion, sexually transmitted diseases (STDs), and sex education and health care in schools.[4]

2. Sinners versus victims

The behavior that the public views as personally controllable is fundamental to whether they see people as sinners or victims. Such perceptions have political salience as well and affect conceptions of appropriate social policies. Federal and state government are more likely to provide assistance to those who are not seen as responsible for their vulnerability, such as children, the blind, disabled veterans, and the elderly. When people are seen as responsible for their life circumstances, such as in the case of substance abusers, unwed mothers, or ex-offenders, there is less public compassion and often stigma.[4],[5]

3. Personal control versus scientific paradigms

Conditions such as alcohol abuse and obesity often attributed to lack of personal responsibility or discipline and therefore stigmatized are reframed as they come to be seen as diseases or linked to environmental conditions such as poor food environments that are less under individual control. Lung cancer, once primarily seen as an individual problem resulting from the personal choice to smoke, is now seen increasingly as a public health problem partly because of media exposure of tobacco manufacturers’ efforts to induce addiction.

4. The Dimensions of Vulnerability

Vulnerability involves several interrelated dimensions: individual capacities and actions; the availability or lack of intimate and instrumental support; and neighborhood and community resources that may facilitate or hinder personal coping and interpersonal relationships.

5. Social stress process

The social stress process provides a useful way of thinking about how individuals and communities manage potential adversities. Research on stress elucidates how people come to experience challenging circumstances, potentially caused by socioeconomic deficits, exclusion, illness and disability, and a large number of other potential assaults, and how they are mediated by coping, social supports, and sense of control and mastery.

The resources that prevent harm may come from people’s capacities and resources such as educational preparation, income and wealth, cognitive ability, and planning and preparation or can be drawn from or supplemented by families, social networks, and community resources.[6]

6. Coping mechanisms

Coping is ultimately an individual process but one shaped by community relationships and the neighborhood environment. Neighborhoods are typically composed of individuals whose key statuses are similar. Thus, the people in our neighborhoods, as well as those in our social networks, usually bear statuses more like ours than different. The neighborhood can stand as a context in which people come to witness stressful social disorganization as a normative reality of life.

Value based care is essential for those are exacerbated by stigma, prejudice, and discrimination, which in turn lead to segregation by race and class and high concentrations of devalued people, such as those with serious and persistent mental illnesses and substance abuse disorders and those with a history of arrest and incarceration. These stigmatized populations are commonly excluded as well from public programs designed to aid the “deserving” poor.[7]

7. Social networks and lack of social support Many people in impoverished communities and in much less deprived communities as well, are often vulnerable because of their precarious ties to social networks and lack of needed social supports. Such networks provide both emotional and practical help in dealing with stressors and often make the difference between successful and inadequate coping.

Social isolation is commonly found among the oldest old, whose social networks have become depleted by death and incapacitating illness and among others such as people from households disrupted because of divorce, separation, or death, or people with severe and persistent mental illnesses and other disabilities.

Ultimately value based care is expressed at the individual level, however important the social and neighborhood context. Physical and cognitive impairments and serious, persistent illnesses exacerbate vulnerabilities, and many of these problems, such as very low birth weight, congenital defects, childhood abuse and deprivation, conduct disorder, and learning difficulties, begin early in life and make later problems more likely. Early recognition and intervention often prevent serious harm. Moderating the effects of many of these early personal vulnerabilities depends on good access to high-quality value based medical care and specialized rehabilitation services that are usually less accessible to the poor and uninsured.[8]

8. Temporary Versus Persistent Vulnerabilities

Value based care depends on vulnerabilities, it may be temporary, stressing individuals and groups during particular life crises such as acute illness, family breakup, unemployment, community disasters, or other severe losses. Welfare studies have observed that most people who required assistance needed it only for limited periods before overcoming unemployment and other life crises. But approximately 30 percent of these clients faced adversities that were long term (eight or more years) and extremely difficult to resolve.[8],[9]

Policy Agenda for Vulnerable Individuals, Communities, and Populations

Special communities are those sharing a “stressful social disorganization as a normative reality of life.” They require interventions beyond health care, such as improving schools and involving parents and the community with them; creating employment opportunities; and providing affordable housing, safe places to exercise and congregate, and access to healthier food.

Other populations spread across neighborhoods and communities share specialized needs because of their illnesses, disabilities, or incapacities such as isolated frail elderly people, the seriously and persistently mentally ill, ex-offenders released from jail or prison, or the homeless. A policy agenda on value based care must carefully examine the balance between “upstream” determinants of health and immediate needs.

1. Health care programs for special people

Medical care is our best-funded and most sophisticated system of interventions for special people. Response in other areas of vulnerability including poverty, welfare, child support, and community disorganization is less developed, is less systematic, and has less stable funding. These policies and programs are highly dependent on state and local efforts and those of NGOs. However formidable the problems of our medical care system, they are modest compared to the challenges faced by organizations designed to deal with sustained poverty, foster children, and depletion of neighborhoods.[10]

2. Neighborhood and community context

As evidence grows indicating that neighborhood and community context affects health and welfare beyond personal characteristics and resources, it makes clear the need to design improved interventions at the community level. Degraded neighborhoods can be targeted for intensive interventions, including the many areas crucial to quality of life such as housing stock, employment opportunities, transportation, safety and freedom from victimization, educational enrichment, and recreational opportunities. These are longstanding but inadequately addressed concerns.[10]

  Conclusion Top

The value based care is very essential which governs how caregivers ought to act in certain situations within a health or social care setting, to be certain that they are not discriminating, violating people’s rights, or providing poor care for their clients. It helps to improve client’s quality of life by setting standards and guiding professional practice.

  References Top

Value based health care delivery model. The International Foundation of Employee Benefit Plans.www.ifebp.org  Back to cited text no. 1
D.M. Cutler, A.B. Rosen, and S. Vijan, “The Value of Medical Spending in the United States, 1960–2000,” New England Journal of Medicine,2006; 9 : 92  Back to cited text no. 2
S.W. Bloom, The Word as Scalpel: A History of Medical Sociology (New York: Oxford University Press, 2002).  Back to cited text no. 3
J.M. McGinnis and W.H. Foege, “Actual Causes of Death in the United States,” Journal of the American Medical Association. 1993;18 : 2207–2212.  Back to cited text no. 4
L.A. Aday, At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States, 2d ed. (San Francisco: Jossey-Bass, 2001).  Back to cited text no. 5
J.W. Kingdon, Agendas, Alternatives, and Public Policies (Boston: Little, Brown, 1984).  Back to cited text no. 6
J.A. Morone, Hellfire Nation: The Politics of Sin in American History (New Haven, Conn.: Yale University Press, 2003  Back to cited text no. 7
A. Morone, “Morality, Politics, and Health Policy,” in Policy Challenges in Modern Health Care, ed. D. Mechanic et al. (New Brunswick, N.J.: Rutgers University Press, 2005), 17  Back to cited text no. 8
8.K.D. Brownell and K.B. Horgen, Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, and What We Can Do about It (Chicago: Contemporary Books, 2004).  Back to cited text no. 9
A.M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America (New York: Basic Books, 2007).  Back to cited text no. 10


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