Modified Rand/UCLA Delphi Consensus of Recommendations to Advance Towards a Value-based Healthcare Model for the Argentine Health System

Abstract

BackgroundHealthcare spending in Argentina has risen significantly, yet the system remains inefficient, fragmented, and inequitable, leading to poor outcomes and resource waste. Stakeholders often have conflicting priorities, further complicating quality and sustainability. The study aimed to identify recommendations to advance the implementation of a Value-Based Healthcare (VBHC) model in the Argentine health system.MethodsA modified RAND/UCLA Delphi consensus process was conducted, involving three rounds of expert consultation. The study was conducted within the Argentine health system, involving experts from various levels of care (primary, secondary, and tertiary) and sectors (public, private, and academic). The geographical focus was Argentina, a middle-income country with a fragmented health system. The Delphi panel comprised 21 health sector experts who completed three consultation rounds (two online and one in-person). Evaluation criteria for each recommendation included impact, resources, feasibility, acceptability, and measurability. Agreement among experts was also evaluated. The two parameters categorised recommendations as appropriate, uncertain, or inappropriate. Exploratory follow-up in-depth interviews were carried out to contextualise the findings.ResultsTwenty-one experts participated. Seven recommendations scored highest in the impact criterion, indicating their potential to advance VBHC. These recommendations faced low feasibility and acceptability scores, reflecting systemic unpreparedness. No specific recommendation achieved agreement on all criteria with an overall median score above 7, ie, appropriate. Follow-up interviews highlighted barriers such as policy constraints, system fragmentation, political and economic instability, and concerns about sustainability.ConclusionsThe study underscores the significant interest in transforming the Argentine health system towards VBHC but reveals substantial systemic and structural barriers. The findings highlight the need for further research, dialogue, and collaboration to address feasibility and acceptability challenges. Future studies should explore strategies to overcome policy and structural barriers and the role of political and economic stability in enabling VBHC implementation.