Healthcare's pay-per-service methodology has become an addiction, and one with very serious consequences for the industry. Physicians are paid for every test, procedure and treatment they provide and hospitals have become not only accustomed to these payments, but dependent on them as a source of continuous income. @RobertPearlMD discusses this issue in his latest article 'Healthcare's Dangerous Addiction to pay-per-service'. This approach has the obvious impact of driving up costs without any associated improvements in care for patients. The Affordable Care Act tried to refocus Healthcare away from this status quo towards increasing value however, it is sadly clear this hasn't taken hold to the extent required to enact real change.

At the same time we hear and see our clients striving to show value beyond the pill, to provide value added services alongside their products to sway a favourable payer reimbursement decision and a drive to be more patient-centric in clinical trials, treatment pathways and internally. Yet all of these activities are being undermined by this pay-per-service addiction.

For example, Patient Support Programs (PSPs) have become a commonplace offering within many therapy areas, although initially they were a differentiator. Whilst their benefit to the patients, physicians and payers is not unanimous, many patients enrolled are positive about their experiences and participation can improve adherence yet patients may only be enrolled if their physician or pharmacist is paid to do so rather than if enrollment is in the best interest of the patient.

All of our clients strive to be patient centric; some go further by enshrining this in their corporate strategy, engaging patients early in trial designs and working closely with patient associations yet the pay-per-service addiction by physicians and hospitals can hinder these good intentions becoming a reality. Physicians still hold much of the power in consultations with patients making satisfying their addiction a priority at the expense of the patient.

Without kicking the habit, future services for patients may not take hold without a pay-for-service approach to entice use. Pay-per-service will continue to influence the use of tests, procedures and treatments to a far greater extent than desired whilst simultaneously distracting us from the much needed conversation about whether developments are really innovative, address an unmet need, provide a benefit to the wider healthcare system and align to a patient centric model.