Medical Students’ Awareness About Value-Based Health Care in Brazil: A Cross Sectional Study

Background: The rising healthcare costs demand a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. This requires all future doctors to understand VBHC. We aimed to evaluate VBHC awareness-level among Brazilian medical students and to identify the associated intrinsic/extrinsic factors. Methods: This was a survey based, cross-sectional study, conducted through an online survey applied to students from Brazilian medical schools. A descriptive analysis based on participants' level of awareness about VBHC was performed. The categorical variables included were absolute and relative frequencies using chi square tests. A multivariate binary logistic regression analysis was performed by calculating the odds ratio (OR) and 95% confidence intervals (95%CI), to compare each response according to VBHC awareness. Results: We collected 3030 responses, from 148 Medical Schools across all Brazilian states. Medical students were compared in 2 groups; 1 was familiar with VBHC (14%; 426); 2 was not (86%; 2575). The univariate analysis showed that group 1 was more willing to share clinical outcomes/costs data related to their practice (57.04%) compared to 2 (48.12%). The multivariate analysis showed that internship experience was the most relevant factor associated with VBHC exposure (OR 4.32 [CI 95% 1.82 - 10.24]). Conclusion: We found that few medical students understand VBHC concepts, and that exposure was due to self-education efforts. Our results suggest that medical schools have the potential to reinforce both intrinsic and extrinsic factors related to VBHC knowledge to prepare future doctors to practice in a value-driven context.