Keywords
value-based healthcare
PROMs
PREMs
QALY
CUR
HTA
MCDA
sustainability
composite index
How to Cite
Abstract
The article presents a conceptualization of people-centred healthcare as a synthesis of the value-based model (Value-Based Healthcare) and the socially integrative approach to the organization of medical care. The theoretical part substantiates the multidimensional nature of the “value” category (allocative, technical, personal, societal) and compares it with the Russian five-component framework developed by the Centre for Health Assessment – community, criticality, control, sufficiency, and monitoring. Methodologically, the study demonstrates how the indicators PROMs, PREMs, QALY, and CUR are integrated into an aggregated index of system resilience through normalization and data weighting within the logic of a balanced scorecard approach. Based on regional data for 2019–2021, spatial differences in values were identified: stabilization of control and monitoring parameters, alignment of sufficiency values, and persistent high differentiation in criticality. It was found that regions with higher PROM scores show better CUR dynamics, reflecting the “value-based” nature of improvements rather than a simple increase in service volumes. The practical significance of the study lies in the development of a comprehensive measurement framework for institutionalizing people-centered metrics in Russian performance evaluation standards. Management tools such as HTA and MCDA are considered as mechanisms ensuring robust decision-making under uncertainty. Prospects for further research include the digitalization of PROMs registries, the expansion of ICHOM indicator sets, and refinement of the sustainability index weights based on expert assessments and panel observations. Limitations are associated with the availability of comparable data and variability in PROMs collection methods; future directions include scaling digital platforms and improving weighting procedures through expert validation and longitudinal data analysis.
References
1. Всемирная организация здравоохранения. A global review of value-based care: theory, practice and lessons learned. Нью-Дели: Представительство ВОЗ в Индии, 2025. – 114 с.
2. Зуенкова Ю. А. Ценностно-ориентированный подход: анализ руководства Европейского института инноваций и технологий / Ю. А. Зуенкова // Медицинские технологии. Оценка и выбор. – 2021. – № 1(43). – С. 28–35.
3. Porter M. E. Defining and introducing value in health care // Evidence-Based Medicine and the Changing Nature of Health Care: IOM Annual Meeting Summary. 2008. P. 161–172.
4. Ходакова О. В., Евстафьева Ю. В., Деев И. А., Кобякова О. С. Система здравоохранения, основанная на ценностях (систематический обзор) / О. В. Ходакова, Ю. В., Евстафьева, И. А. Деев [и др.] // Здравоохранение РФ. – 2023. – № 1. URL: https://cyberleninka.ru/article/n/sistema-zdravoohraneniya-osnovannaya-na-tsennostyah-sistematicheskiy-obzor (дата обращения: 07.11.2025).
5. Швец Ю. Ю. Применение подходов робастного управления для перехода к ценностно-ориентированному здравоохранению / Ю. Ю. Швец // Проблемы социальной гигиены, здравоохранения и истории медицины. – 2023. – № S2. URL: https://cyberleninka.ru/article/n/primenenie-podhodov-robastnogo-upravleniya-dlya-perehoda-k-tsennostno-orientirovannomu-zdravoohraneniyu (дата обращения: 07.11.2025).
6. Mayora C. et al. Health Technology Assessment (HTA) readiness in Uganda: stakeholder’s perceptions on the potential application of HTA to support national universal health coverage efforts // medRxiv. 2023. DOI: 10.1101/2023.05.16.23290024.
7. Neumann P. J., Garrison L. P., Willke R. J. The history and future of the “ISPOR Value Flower”: addressing limitations of conventional cost-effectiveness analysis // Value in Health. 2022. Vol. 25, No. 4. P. 558–565.
8. Бударин С. С. Опыт реализации проектов по внедрению ценностно-ориентированного здравоохранения в зарубежных странах / С. С. Бударин, Д. П. Дербенев, Ю. В. Эльбек // Проблемы социальной гигиены, здравоохранения и истории медицины. – 2024. – № S2. URL: https://cyberleninka.ru/article/n/opyt-realizatsii-proektov-po-vnedreniyu-tsennostno-orientirovannogo-zdravoohraneniya-v-zarubezhnyh-stranah (дата обращения: 07.11.2025).
9. Яшин С. Н. Трансформация менеджмента стоматологических организаций в условиях перехода на ценностно-ориентированную модель здравоохранения / С. Н. Яшин, И. Н. Авдеева, О. А. Алешина // Экономика и управление. – 2023. – № 11. URL: https://cyberleninka.ru/article/n/transformatsiya-menedzhmenta-stomatologicheskih-organizatsiy-v-usloviyah-perehoda-na-tsennostno-orientirovannuyu-model (дата обращения: 07.11.2025).
10. Burwell S. M. Setting value-based payment goals – HHS efforts to improve U.S. health care // The New England Journal of Medicine. 2015. Vol. 372, No. 10. P. 897–899.
11. Koff E., Pearce S., Peiris D. P. Collaborative commissioning: regional funding models to support value-based care in New South Wales // The Medical Journal of Australia. 2021. Vol. 215, No. 7. P. 297.
12. Зигангареева Г. Г. Организационно-финансовые аспекты выбора интраокулярных линз при хирургии катаракты в условиях ценностно-ориентированной системы здравоохранения / Г. Г. Зингареева, О. И. Королева, Д. К. Хусаинова // Менеджер здравоохранения. – 2024. – № 9. URL: https://cyberleninka.ru/article/n/organizatsionno-finansovye-aspekty-vybora-intraokulyarnyh-linz-pri-hirurgii-katarakty-v-usloviyah-tsennostno-orientirovannoy (дата обращения: 07.11.2025).
13. Зуенкова Ю. А. Дорожная карта модернизации онкологической службы на основе ценностно-ориентированного подхода / Ю. А. Зуенкова // Медицина и организация здравоохранения. – 2023. – № 1. URL: https://cyberleninka.ru/article/n/dorozhnaya-karta-modernizatsii-onkologicheskoy-sluzhby-na-osnove-tsennostno-orientirovannogo-podhoda (дата обращения: 07.11.2025).
14. Хайруллин И. И. Результаты адаптации инструментов стандартизации ценностно-ориентированных исходов: анализ наборов параметров ICHOM / И. И. Хайруллин, В. В. Омельяновский, Р. В. Гостищев [и др.] // Фармакоэкономика. Современная фармакоэкономика и фармакоэпидемиология. – 2025. – № 2. URL: https://cyberleninka.ru/article/n/rezultaty-adaptatsii-instrumentov-standartizatsii-tsennostno-orientirovannyh-ishodov-analiz-naborov-parametrov-ichom (дата обращения: 07.11.2025).
15. Куроедов А. В. Клинико-экономические подходы в лечении больных глаукомой / А. В. Куроедов // Офтальмологические ведомости. – 2010. – № 1. URL: https://cyberleninka.ru/article/n/kliniko-ekonomicheskie-podhody-v-lechenii-bolnyh-glaukomoy (дата обращения: 07.11.2025).
16. Кобякова О. С. Модель автоматизации системы сбора статистической информации о показателях системы здравоохранения на основании первичных данных / О. С. Кобякова, Н. А. Голубев, А. В. Поликарпов [и др.] // Профилактическая медицина. – 2023. – Т. 26. – № 1. – С. 11–16. https://doi.org/10.17116/profmed20232601111
17. Paul J. A., Wang X. J. Robust location-allocation network design for earthquake preparedness // Transportation Research Part B: Methodological. 2019. Vol. 119. P. 139–155.
18. Айтян Т. В. Сравнение систем лекарственного обеспечения в Европе и США. Уроки для России / Т. В. Айтян // Региональная экономика: теория и практика. – 2018. – Т. 16. – № 4. – С. 624–639.
19. Гаитова К. К. Фармакоэкономический анализ вакцинопрофилактики гриппа с применением тривалентной вакцины в условиях здравоохранения Казахстана / К. К. гаитова, Е. А. Тамамбеков, А. Б. Табаров [и др.] // Journal of Health Development. – 2021. – № 41. URL: https://cyberleninka.ru/article/n/farmakoekonomicheskiy-analiz-vaktsinoprofilaktiki-grippa-s-primeneniem-trivalentnoy-vaktsiny-v-usloviyah-zdravoohraneniya (дата обращения: 07.11.2025).
20. Омельяновский В. В. Концепция ценностно-ориентированного здравоохранения / В. В. Омельяновский, Н. З. Мусина, Р. В. Гостищев [и др.] // Фармакоэкономика. Современная фармакоэкономика и фармакоэпидемиология. – 2020. – Т. 13. – № 4. – С. 438–451.
21. ЕМИСС: официальные статистические показатели [Электронный ресурс]. URL: https://www.fedstat.ru/ (дата обращения: 07.11.2025).
1. World Health Organization (2025). A Global Review of Value-Based Care: Theory, Practice and Lessons Learned. New Delhi: WHO Country Office for India.
2. Zuyenkova, Yu.A. (2021). Tsennostrno-orientirovannyy podkhod: analiz rukovodstva Evropeyskogo instituta innovatsiy i tekhnologiy [Value-based healthcare: analysis of European Institute of innovation and technology health guidelines]. Meditsinskie tekhnologii. Otsenka i vybor [Medical Technologies. Assessment and Choice], 1(43), 28–35. (In Russ.).
3. Porter, M.E. (2008). Defining and introducing value in health care. Evidence-Based Medicine and the Changing Nature of Health Care: IOM Annual Meeting Summary, 161–172.
4. Khodakova, O.V., Evstafyeva, Yu.V., Deev, I.A., & Kobyakova, O.S. (2023). Sistema zdravookhraneniya, osnovannaya na tsennostyakh (sistematiчeskiy obzor) [Values-based healthcare (systematic review)]. Zdravookhranenie Rossiiskoi Federatsii [Health Care of the Russian Federation, Russian journal], 1, 3–11. URL: https://cyberleninka.ru/article/n/sistema-zdravoohraneniya-osnovannaya-na-tsennostyah-sistematicheskiy-obzor (Accessed on November 07, 2025). (In Russ.).
5. Shvets, Yu.Yu. (2023). Primenenie podkhodov robastnogo upravleniya dlya perekhoda k tsennostno-orientirovannomu zdravookhraneniyu [Applying robust management approaches to transit to value-based healthcare]. Problemy sotsialnoy gigieny, zdravookhraneniya i istorii meditsiny [Problems of Social Hygiene, Healthcare and History of Medicine], S2, 45–52. URL: https://cyberleninka.ru/article/n/primenenie-podhodov-robastnogo-upravleniya-dlya-perehoda-k-tsennostno-orientirovannomu-zdravoohraneniyu (Accessed on November 07, 2025). (In Russ.).
6. Mayora, C. et al. (2023). Health Technology Assessment (HTA) readiness in Uganda: stakeholder perceptions on the potential application of HTA to support national universal health coverage efforts. medRxiv. DOI: 10.1101/2023.05.16.23290024.
7. Neumann, P.J., Garrison, L.P., & Willke, R.J. (2022). The history and future of the “ISPOR Value Flower”: addressing limitations of conventional cost-effectiveness analysis. Value in Health, 25(4), 558–565.
8. Budarin, S.S., Derbenev, D.P., & Elbek, Yu.V. (2024). Opyt realizatsii proektov po vnedreniyu tsennostno-orientirovannogo zdravookhraneniya v zarubezhnykh stranakh [Experience in implementing projects on the introduction of value-based healthcare in foreign countries]. Problemy sotsialnoy gigieny, zdravookhraneniya i istorii meditsiny [Problems of Social Hygiene, Healthcare and History of Medicine], S2. URL: https://cyberleninka.ru/article/n/opyt-realizatsii-proektov-po-vnedreniyu-tsennostno-orientirovannogo-zdravoohraneniya-v-zarubezhnyh-stranah (Accessed on November 07, 2025). (In Russ.).
9. Yashin, S.N., Avdeeva, I.N., & Aleshina, O.A. (2023). Transformatsiya menedzhmenta stomatologicheskikh organizatsiy v usloviyakh perekhoda na tsennostno-orientirovannuyu model zdravookhraneniya [Transformation of management of dental organizations in the conditions of transition to a value-based healthcare model]. Ekonomika i upravlenie [Economics and Management], 11. URL: https://cyberleninka.ru/article/n/transformatsiya-menedzhmenta-stomatologicheskih-organizatsiy-v-usloviyah-perehoda-na-tsennostno-orientirovannuyu-model (Accessed on November 07, 2025). (In Russ.).
10. Burwell, S.M. (2015). Setting value-based payment goals – HHS efforts to improve U.S. health care. The New England Journal of Medicine, 372(10), 897–899.
11. Koff, E., Pearce, S., & Peiris, D.P. (2021). Collaborative commissioning: regional funding models to support value-based care in New South Wales. The Medical Journal of Australia, 215(7), 297.
12. Zigangareeva, G.G., Koroleva, O.I., & Khusainova, D.K. (2024). Organizatsionno-finansovye aspekty vybora intraokuliarnykh linz pri khirurgii katarakty v usloviyakh tsennostno-orientirovannoy sistemy zdravookhraneniya [Organizational and financial aspects of choosing intraocular lenses in cataract surgery in a value-based heatth care system]. Manager Zdravoohranenia [Healthcare Manager], 9. URL: https://cyberleninka.ru/article/n/organizatsionno-finansovye-aspekty-vybora-intraokulyarnyh-linz-pri-hirurgii-katarakty-v-usloviyah-tsennostno-orientirovannoy (Accessed on November 07, 2025). (In Russ.).
13. Zuyenkova, Yu.A. (2023). Dorozhnaya karta modernizatsii onkologicheskoy sluzhby na osnove tsennostno-orientirovannogo podkhoda [Value-based approach to road map of modernization of the oncological care]. Meditsina i organizatsiya zdravookhraneniya [Medicine and Healthcare Organization], 1. URL: https://cyberleninka.ru/article/n/dorozhnaya-karta-modernizatsii-onkologicheskoy-sluzhby-na-osnove-tsennostno-orientirovannogo-podhoda (Accessed on November 07, 2025). (In Russ.).
14. Khayrullin, I.I., Omelyanovskiy, V.V., & Gostishchev, R.V. et al. (2025). Rezultaty adaptatsii instrumentov standartizatsii tsennostno-orientirovannykh iskhodov: analiz naborov parametrov ICHOM [Results of adaptation of tools for standardizing value-based outcomes: analysis of ICHOM Standard Sets]. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya [FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology], 2. URL: https://cyberleninka.ru/article/n/rezultaty-adaptatsii-instrumentov-standartizatsii-tsennostno-orientirovannyh-ishodov-analiz-naborov-parametrov-ichom (Accessed on November 07, 2025). (In Russ.).
15. Kuroedov, A.V. (2010). Kliniko-ekonomicheskie podkhody v lechenii bolnykh glaukomoy [Medico-economic approaches in the treatment of glaucoma patients (review of literature)]. Oftal’mologicheskie vedomosti [Ophthalmic Reports], 1. URL: https://cyberleninka.ru/article/n/kliniko-ekonomicheskie-podhody-v-lechenii-bolnyh-glaukomoy (Accessed on November 07, 2025). (In Russ.).
16. Kobyakova, O.S., Golubev, N.A., Polikarpov, A.V., & Sidorov, K.V. (2023). Model’ avtomatizatsii sistemy sbora statisticheskoy informatsii o pokazatelyakh sistemy zdravookhraneniya na osnove pervichnykh dannykh [Data collection system automation model on health system indicators based on primary data]. Profilakticheskaya meditsina [Russian Journal of Preventive Medicine], 26(1), 11–16. (In Russ.).
17. Paul, J.A., Wang, X.J. (2019). Robust location-allocation network design for earthquake preparedness. Transportation Research Part B: Methodological, 119, 139–155.
18. Aityan, T.V. (2018). Sravnenie sistem lekarstvennogo obespecheniya v Evrope i SShA. Uroki dlya Rossii [Comparison of drug supply systems in Europe and the USA: lessons for Russia]. Regionalnaya ekonomika: teoriya i praktika [Regional Economics: Theory and Practice], 16(4), 624–639. (In Russ.).
19. Gaitova, K.K., Tamabekov, E.A., Tabarov, A.B. et al. (2021). Farmakoekonomicheskiy analiz vaktsinoprofilaktiki grippa s primeneniem trivalentnoy vaktsiny v usloviyakh zdravookhraneniya Kazakhstana [Pharmacoeconomic Analysis of Influenza Vaccine Prophylaxis Using Trivalent Vaccine in the Conditions of Healthcare in Kazakhstan]. Journal of Health Development, 41. URL: https://cyberleninka.ru/article/n/farmakoekonomicheskiy-analiz-vaktsinoprofilaktiki-grippa-s-primeneniem-trivalentnoy-vaktsiny-v-usloviyah-zdravoohraneniya (Accessed on November 07, 2025). (In Russ.).
20. Omelyanovskiy, V.V., Musina, N.Z., & Gostishchev, R.V. et al. (2020). Kontseptsiya tsennostno-orientirovannogo zdravookhraneniya [The concept of value-based healthcare]. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya [FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology],13(4), 438–451. (In Russ.).
21. EMISS: ofitsialnye statisticheskie pokazateli [EMISS: Official Statistical Indicators]. URL: https://www.fedstat.ru/ (Accessed on November 07, 2025). (In Russ.).
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.