LAST week, the Association of Private Hospitals Malaysia (APHM) convened hospital operators, academics and healthcare professionals from around the world to discuss how the industry can move beyond delivering high volumes of care, as is mostly the case now, to delivering better value for patients, and what this actually looks like in practice. 

The conference felt timely for where we are as a nation. As healthcare costs continue to rise and patients become more informed about the care they receive, it is important to understand what value-based healthcare really means, how it changes the way care is delivered, and what it means for the cost of receiving that care.

The traditional mindset of healthcare delivery

Healthcare systems around the world traditionally measure success by volume, looking at how many patients were treated, how many procedures were performed, how many beds were occupied, and so on. 

On the part of patients, many understandably would feel reassured when more laboratory tests are ordered, more scans are performed, or more expensive procedures are recommended, especially when insurance covers much of the cost. Coupled with insurance coverage, it creates a “buffet syndrome” behaviour where the assumption becomes “the more tests, the better” or “the more money I spend on this justifies the premium I pay annually”. 

However, there is a shift happening where more countries are recognising that “more” or “volume” is not a good enough measure for healthcare delivery. 

At this conference, we were fortunate to have global speakers share what value-based healthcare looked like in practice. 

A speaker who is a practicing surgeon from Singapore shared how her team began tracking just one indicator every week: the number of patients who required readmission within 30 days after knee replacement surgery. Previously, this data was reviewed only once every few months. Through weekly monitoring, the hospital was able to identify patterns and address problems earlier and more which resulted in a reduction of avoidable readmissions.

Another speaker from a hospital in China tackled something every patient immediately understands, which is waiting time. This Chinese hospital redesigned its emergency department processes to reduce waiting times by approximately 20 minutes. The hospital displayed those waiting times publicly so patients could see how the hospital was performing in real time.

In these examples, neither hospital relied on revolutionary technology to deliver better value to patients. Importantly, they also did not need to increase patient bills to achieve better outcomes. Instead, they focused on measuring what mattered most to patients which were reducing avoidable readmissions and shortening waiting times, and used those insights to improve the care they provided.

So what does this mean for hospitals and patients?

Hospitals will have to re-evaluate what matters most to patients and identify the most effective ways to deliver the best possible outcomes based on this. In practice, this means perhaps having refreshed standardised processes that help patients recover faster, reduce hospital stays, lower the risk of complications, reduce waiting times, and minimise the likelihood of readmission. So the focus shifts from doing more to doing what works best for the patient efficiently. 

For patients, it simply means better outcomes. But I would also like to address the question of cost, which many patients understandably have. 

If you ask patients what they are paying for at private hospitals today, many would say they are paying for comfort such as a private room, shorter waiting times, access to specialists of their choice, or more personalised attention. 

However, these visible comforts represent only a small part of the overall cost of delivering private healthcare, as much of what patients are actually paying for is invisible.

Take medical technology as an example. Heavy diagnostic imaging equipment such as MRI scanners, CT scanners and PET systems can cost between US$1 million and US$3 million each. Robotic surgical systems such as the Da Vinci platform require even greater investment. Monitoring equipment and laboratory systems too can each cost well over USD1 million. 

Beyond the initial purchase of these technologies, hospitals need to maintain, calibrate and eventually replace these machines to ensure they continue producing accurate, high-quality results. 

At the same time, hospitals invest in the training of nurses and allied health professionals as well as internationally recognised accreditation, stringent infection prevention protocols, continuous staff training, and countless safety measures that patients may never see. Patients rarely notice these systems because, when they work well, they prevent problems before they occur.

So, more than just comfort, patients are actually paying for safety, quality, expertise, and reliability.

These investments are what allow hospitals to reduce complications, minimise infections, shorten recovery times and improve clinical outcomes. They also give patients confidence that, should complications arise, the right people, equipment and protocols are already in place to provide the best possible care.

I am certain many patients would then ask, in light of all this, whether value-based healthcare would cost more than what they are paying today.

The answer is: value-based healthcare is not simply about investing more or charging patients more, rather,  it is about making every ringgit spent deliver better outcomes for patients.

For many years, many have equated more care with better care. However, the best care is not necessarily the most care. Consider how an unnecessary investigation would add cost without improving health, and how a longer hospital stay would increase expenses without adding value if the patient is already well enough to recover at home. Even the most sophisticated technology has little value if it does not improve patient outcomes. 

Recognising this, many healthcare systems around the world are shifting from measuring activity to measuring outcomes, and it is time Malaysia does the same. 

This approach also encourages hospitals to become more transparent and accountable. Rather than simply highlighting advanced facilities or the latest technology, through a value-based approach, hospitals would be able to demonstrate their performance through measurable outcomes and patient experience.

While individual patient bills will continue to vary depending on their medical needs, the broader goal of value-based healthcare is to ensure that healthcare resources are used more wisely. This is important for Malaysia, where the World Bank Group has identified overconsumption of healthcare services as one of the contributing factors to rising medical costs. By focusing on the right care at the right time, not simply more care, we can reduce unnecessary spending while improving outcomes for patients.

Value-based healthcare is not just about changing how hospitals deliver care. It is also about good partnership between patient and doctor, as well as changing the way patients think about healthcare. 

Instead of equating more tests, more procedures, or longer hospital stays to better care, patients can work closely with their doctors to understand their condition, the treatment options available, and what is truly necessary for the best possible outcome. 

Patients should also feel comfortable asking how patient safety is monitored at the hospital, and how the hospital measures quality outcomes. They should also feel empowered to ask why a particular test or procedure is recommended, what alternatives are available, and how it will improve their recovery.

Hospitals that are committed to continuous improvement should welcome these conversations because informed patients are partners in delivering better healthcare. 

The goal is not to provide more care, but to provide the right care. 

At one of the final sessions of APHM’s 32nd Conference, a hospital operator from India shared a story that stayed with me. His hospital performed India’s first-ever liver transplant on a child. Today, that child is a doctor. The operator, who is also a professor, spoke about the importance of staying “high touch”. He said that as much as healthcare moves toward “high tech”, we must never lose focus on the human element of healthcare delivery. 

To me, that is the essence of value-based healthcare. Putting the patient foremost. 

Shifting from volume to value is not something hospitals can do alone. It requires hospitals to reevaluate and refresh how care is delivered, and, just as importantly, it asks something of patients too: understanding and using primary care appropriately, and learning to choose better outcomes over more consumption.

I want to assure patients that the Association of Private Hospitals is committed to making that shift towards value-based healthcare, which, in the simplest terms, means ensuring that every patient who walked into a private hospital sick, walked out better, without being put through unnecessary tests or made to pay more than was needed. 

It may not always look “cheaper” on an individual bill, but at a national level, the overall cost of care improves, and healthcare inflation is kept in check.

As private hospitals in Malaysia, we have built something the world genuinely respects. My hope, both as a doctor and as someone now speaking for the private hospital sector, is that all of us, patients, hospitals, and government alike, keep building on that foundation of value, for the good of every patient we serve, today and in the years to come.

Datuk Dr Kuljit Singh is an ENT specialist, president of the Association of Private Hospitals Malaysia (APHM), and independent director of the Malaysia Healthcare Travel Council (MHTC) Board.