OBJECTIVES:

Global health care systems are facing a fundamental paradigm shift from volume-based, supply-driven models focused around clinicians to value and outcomes-based initiatives focused on patients and populations. The Economist Intelligence Unit (EIU) Global Assessment provides a global perspective on the alignment of countries with key components of VBHC as well as a standardised framework to evaluate aspects of VBHC within a country. Orthopaedics is well placed to adopt VBHC and places a substantial burden on healthcare systems worldwide. The aim of this study was to collaboratively assess the alignment of VBHC within orthopaedics in different countries, using EIU methodology.

METHODS:

EIU assessed countries on their alignment to VBHC using 17 indicators. In the context of Orthopaedics, 7 relevant indicators for country-specific assessment were selected. Countries were categorised according to their overall alignment to VBHC in orthopaedics. Sources of data included: academic organisations; clinical orthopaedic organisations; national registry organisations; and expert opinion.

RESULTS:

• All countries had a national orthopaedic body, but few provided professional training in VBHC. These training programmes were minimal
• More economically developed countries have multiple centres providing data to formal national and internationally linked orthopaedic speciality registries
• Most countries had more than one centre with orthopaedic speciality coordinated care services
• Countries with high levels of healthcare spending also tend towards outcome-based payment approaches in orthopaedics, though bundled-payment systems are not widely implmented

CONCLUSIONS:

• Alignment to VBHC in orthopaedics is in its early phases globally
• Almost universally, countries could improve their alignment with orthopaedic VBHC through the introduction and development of bundled payment models
• Moving towards coordinated orthopaedic care remains a challenge, though progress in this domain appears to be more developed in orthopaedics than in other specialities
• Further analysis of this nature aims to generate an understanding of the global landscape of VBHC from a speciality perspective