A health performance approach must permeate all aspects of health policy, planning, and implementation in order to achieve its goal of transferring predefined policy objectives into health services purchasing decisions. Our point is to provide a critical path through improved use of existing technologies using new, expressive knowledge models to achieve OPL objectives. This will bring credibility to government and satisfaction to the people.
Placed in an environment of fluidity, what should leaders in health-related governance encourage and support? From the OPL health financing point of view, focus on optimal health is critical. Once pernicious diseases are eliminated, the process is just begun. The point is to introduce the set of carefully designed organizational and financial tools reflecting the existing policies and priorities in order to give the population an opportunity to enjoy good health.
The traditional approach, based on fragmented health care model using the family doctor as a gatekeeper, is problematic. What is needed is a functionally integrated health care model. Data needs to constantly be collected and allowed to flow through the system, providing answers to individual and caregivers alike, including such family doctors and other service providers. Interpretive measures, designed by experts and authorities, would thus serve as meeting points for people and elements of the health system – interactively linking people, regulators, payers and health care providers.
Such functions, including the ongoing services of high-volume data collection centers, should operate based on agreed-upon criteria and clear tariffs as defined in a related purchasing model, all integrated into the logic of the system. In order to translate above mentioned national and local health policy into purchasing decisions, regulators need to operate based on pre-agreed-upon health services plans, final payment provided only when procedures are carried out in harmony with data in the system and associated processes.
Existing payment models based on the predefined lists of procedures require smart bundling in order to go towards the more prevention oriented model. The associated planning processes should involve direct participation, including system design activities, by representative people, payers, providers, and regulators. Purchasing decisions will thus reflect:
Peoples' need for clearly-defined, interactive sets of procedures, tools, and technologies that are integrated and easily followed, a “virtual one stop shop”.
Payers' need for knowledge-based health services planning models that are based on consultations among people, providers, and regulators. These models need to be adaptable to ongoing, changing priorities and new findings in the science and practice, as updated in the system by associated experts and authorities.
Regulators' need for service plans developed by payers and used as inputs for national and local health planning. This includes data outlining needed infrastructure, manpower, research commitments, etc.
Health and medical services providers' need to plan profitable programs, accounting for investment requirements, ongoing costs, and other business factors. They need to be able to see clear paths to prosperity aligned with objectives of the system, including elimination of disease, promoting health, etc.
The ultimate objective of the OPL health financing model is to implement a strategic health and medical purchasing model based on dual control principles as outlined by legislative authorities, where authoritative processes routinely function in harmony with knowledge-based processes and procedures that are driven by facts, not simply intuition, personal prerogative, or incompatible agendas.
Such arrangements make the planetary dream of the people and of good governments come true: Replacement of dysfunctional, simplistic, yet expensive systems and networks with systems based on shared values, deep knowledge, and verifiable performance. Success in such a plan will indeed reflect well on governments in question and will point to additional ways of improving legislative and governance performance while improving the general heath and well-being of the people.