What is “value” in health care?

It is helpful to think of value in healthcare as an equation:

Value = Quality of Care (Outcomes, safety, and service)/Cost [Need to create a graphic for this]

The goal of your health care provider should be to give you the best possible care at the lowest possible cost.Higher quality of care (the numerator) and lower cost (the denominator) equals greater value in health care.

More is not always better.

It’s tempting to think that more is better. More tests, more doctor visits, more medication, and more procedures. "Supersize" my health care, just like my hamburger, right?

Not necessarily. More is not always better when it comes to health care. Everyone should receive all the medical care that is necessary, but often Americans receive far more than they need. This waste increases costs without increasing the quality of care a person receives. As a result, their health care value decreases.

As an example, here’s a true story about a patient’s experience:

An older gentleman was taken to the emergency room after a fainting spell. The doctors ordered a CT scan of his heart, which showed some calcification in the arteries. The physicians scheduled and performed heart catheterization and bypass surgery. Later a stress test revealed an abnormality, so they performed a second catheterization and discovered a blockage in one of the bypasses. He had another procedure to place stents in the blocked artery.

Unfortunately, his fainting spells continued. Frustrated, the patient did some research and chose a high-value medical center to treat him. There, doctors conducted a lengthy assessment of the patient’s entire medical history, condition, and treatments. They determined that his medications had been interacting incorrectly and causing his fainting. They made adjustments to his prescriptions, and the fainting spells stopped.

The catheterizations, surgeries and stents were completely unnecessary. The cost of these procedures was enormous but the outcome was awful. He didn’t get better, so the care he received provided no value at all.

It’s easy for us to say, in retrospect, that he received unnecessary treatments. It’s much harder when it’s your own health on the line, and it’s natural to want all your bases covered. Most of us aren’t medically trained, so it’s impossible for us to know what care is reasonable and what is wasteful. We have to rely on the guidance of our physicians when we make health care decisions, but our current health care system doesn't encourage providers to consider value as a high priority.

Quality, not quantity, should drive treatments.

A major part of the problem is that most of America’s health care system operates on a "fee-for-service" model, meaning providers get paid for each test and procedure a patient receives. In other words, providers are compensated according to the quantity of care they deliver, not necessarily the quality. Patients want the very best care and often assume that more is better, so they willingly encourage providers to do more. The combination of patient pressure and financial incentives to do more tests and procedures inevitably results in costly and unnecessary medical care. This is what we call low-value health care. 

Crucial steps toward providing high-value care include:

Eliminating the financial incentives providers have to over-treat.

Encouraging physicians to spend more time examining and talking with patients to discover the root of their problems, and to consult with other physicians from multiple specialties to determine what’s best for each patient.

Utilizing electronic health records to eliminate hassle and ensure accuracy.

Taking these steps can ensure that health care is as affordable as possible, while achieving the best possible outcomes for patients. This is high-value care.