Some Thought on Value in Healthcare

Value is a dirty word in healthcare, conjuring up visions of ruthless bean counters, scrabbling for pennies while patients suffer. How different though is the reality? Regardless of location, healthcare costs are rapidly climbing, disease burdens, therapies, diagnostics and expectations are rising faster. Like it or not, hard choices must be made, if not by clinicians, then by the payer, ultimately the taxpayer. How does one align this imperative with the need to ensure quality of care is optimized?
A recent paper by former colleagues of mine brought home the reality of this dilemma. Cruz et al sought to improve compliance with goal directed therapy for children with sepsis. They demonstrated a marked reduction in time to first fluid and antibiotic administration, consistent with guideline recommendations. However, part of the solution was to deploy extra nursing, pharmacy, medical and EMT staff. While this may well have been a beneficial use of this scarce resource, it is unclear if the value increased.
Value can be defined as health outcomes (quality) divided by the cost of achieving those outcomes. So while quality almost certainly increased, it is likely that the cost of achieving this level of quality also increased. The question that must be asked, could better or more health outcomes be achieved for the same expenditure. Unfortunately our measurement systems are as yet unable to answer this question. For a more detailed discussion around this topic, please see Michael Porters website.