The Economist (Intelligence Unit) – Creating Healthy Partnerships (2019)

10

THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS

But whose value matters?

The obvious issue in a value-based system is how, and by whom, “value” is defined. The debate is far

from moot. In countries with a single-payer health system, such as the UK, one understanding of value

is how to distribute inevitably limited resources between diseases and regions in order to have the

biggest positive impact on population-wide health. For a health provider, however, it can simply be

another way to describe basic efficiency.^14

VBHC advocates, though, typically see value as pertaining to outcomes that matter to the patient.

In practice, however, the patient voice has often been absent when selecting the outcomes that

ostensibly matter in this way. As Alan Balch, CEO of the US National Patient Advocate Foundation,

puts it, “we have tried to transition to a value-based model without truly understanding what value is

and how to create it for patients. The system as a whole is trying to catch up and learn what it means

for patients.”

Indeed, the extent to which patients have had a meaningful role in creating the growing number

of value frameworks in the US is unclear, as is the degree of their influence in other countries

despite sometimes having a formal role in certain aspects of healthcare decision-making.^15 For

Axel Mühlbacher, professor of health economics and healthcare management at the Institut

Gesundheitsökonomie und Medizinmanagement (Health Economics and Healthcare Management

Institute) in Germany, such a situation is untenable.

“Value cannot be defined without the consumer. Who will define it for you and me if it is not us? We

transferred some decision rights to healthcare systems because of information asymmetry, but we did

not give them the right to put in their value judgements rather than the patient’s preferences. There is a

fine line between democracy and dictatorship.” Similarly, Ms Perfetto explains that any new framework

to define value “should look at what patients want and what will help them reach their goals.”

Accordingly, this report, when discussing patient value, or value in general, treats it as based on

outcomes that not only matter to patients but are chosen by them as well.

The implications of such a change in perspective go much further than measuring similar outcomes

with slightly adjusted scales. Several differences are particularly relevant to discussions throughout

this report. First, the outcomes that patients value frequently go beyond traditional notions of clinical

results to include patient experience. Mr Balch notes that “different treatments can have different

impacts on transportation costs, caregiver burden, or work disruption. In some cases, there may be

only one clinical option that is ethically available, but even then there are other things about care which

you can personalise.”

Next, the outcomes that matter will go far beyond traditional ones. The US National Health Council

speaks of a “patient trifecta”—the need to balance potential clinical outcomes, personal circumstances

and life goals when choosing between treatment options.^16

14. For a discussion of the different concepts
    of value, see Muir Gray et al, How to Get
    Better Value Healthcare, 2017.


15. Eleanor Perfetto et al, “Value to Whom?
    The Patient Voice in the Value Discussion,”
    Value in Health, 2017.


16. Marc Boutin, “The Patient Trifecta: A Basis
    for a Truly Patient-Centric Health System,”
    American Journal of Pharmacy Benefits,
    2015