How is high value in health care defined?
The health care sector is characterised by conflicting interests that often vary based on the stakeholder; including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction.
The overarching goal, however, should be high value for patients – value being defined as health outcomes achieved per Euro spent. Improving value is the most effective, reliable way to drive system progress and benefit both provider and recipients of health care. Because the value of health care is measured in results and not inputs, the quality and effectiveness of any given treatment, and its availability at a fair price, is of greater importance than a crude measure of the overall volume of treatment available. Therefore, we suggest a two pronged approach to improving efficiency and value: first, we must optimise services, and second, optimise costs.
Ensuring quality of services
Any assessment of value must be holistic – meeting a range of different criteria that depend on the patient’s medical condition, as well as factors relevant to the carers involved. Different conditions – e.g. a diabetic child or a trauma victim – may require very different assessments of value. With this in mind, physicians should follow this holistic approach and, ideally, have a team of specialists focusing on issues related to medical treatments (e.g. psychological help for parents of a chronically ill child, but also cost effective treatment options to not financially overburden parents).
However even if areas for improvement can be recognised, it is not always easy to implement changes. Improving health care is closely linked with management and leadership development. As frontline health care providers, physicians are increasingly in need of basic managerial and leadership skills. The increasing risk in current practice, however, is that the decision-making processes in hospital organisations are instead dominated by non-physician hospital administrators. (2) Physicians, on the other hand, have been trained to recognise signs and symptoms of diseases and know which therapy options and/or lifestyle changes can alter the course of a disease. What they lack is the implementation of cost-effective management options. Nevertheless, as the patient is at the centre of all considerations (whether cost-effective or not), the treating physician should be at the core of the decision-making process.
The increasing growth in total health expenditure per capita is a worldwide issue, as shown in Figure 1, and is detrimental to value. It is at largely rooted in three physician-driven occurrences: 1) Preventable or avoidable hospital (re)admissions; 2) inappropriate or non-beneficial treatment; and 3) overuse or misuse of diagnostic testing. (3) All of these three cost pressures will also act to lessen the value of care – inconveniencing the patient with unnecessary treatments and investigations, and heightening concerns about minor or non-existent health problems.