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

THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED

CARE IN HEALTH SYSTEMS

Finally, individual patients may see far different outcomes as being ones that matter. Dr Beveridge
explains “a 70-year-old is not usually aiming to run a first marathon but wondering ‘how do I care
for myself so that I can see my grandchild’s wedding?’” Similarly, given a choice of side effects from
different treatments, two otherwise similar patients might well disagree on which they would rather
avoid where possible.

This poses cultural challenges for health systems focused on addressing variations, notes Dr Morrow.
“We need to hammer out unacceptable variation in either access to, or outcomes from, interventions
which may reflect technical competence. Variation in terms of choices, though, should be encouraged.
We need to be careful not to move into statist healthcare, but allow people to make what may seem to
us unwise decisions for themselves, as long they understand what they are doing.”

Patient-centred care: The optimal version of value-based healthcare

VBHC aims to achieve a fundamental reconfiguration of healthcare provision. Instead of organising it
around those administering medical interventions, a focus on results leads to shaping provision around
the patient. This implies the creation of continuous, integrated care provided by multidisciplinary
teams to replace disparate interventions often previously siloed by medical expertise.

Such an approach has numerous advantages, notably including:

 more holistic patient care, which includes prevention and education as well as medical

interventions, and when individuals do present with a specific medical need the choice of therapy

is shaped by the broader context of their specific situation, including, for example, possible

multiple morbidities or living conditions;

 co-operative treatment in which clinicians work together to adjust to such particular needs of

the patient;

 more continuous care, which is easier for the patient to navigate, thereby improving the patient

experience and reducing the number who drop out; and

 reduced cost through eliminating duplication of tests and interventions.

As with the concept of value, perspective matters to how things should be organised. In theory,
integrated care could simply be a refocused, if more efficient, form of clinician-dominated provision.
Patient-centred care, an idea that predates the VBHC debate, but conceptually has become
intertwined with it, goes further. As Ms Perfetto puts it, “patient-centred means you are dedicated not
to doing things for patients, but with patients.”

Francesca Sofia, who is the chief scientific officer of the Federazione Italiana Epilessie, gives an example
of the difference from a recent experience at a large Italian hospital. In that institution, she was told,
patients were welcome to give information to other patients or engage in auxiliary activities, but that
something like a patient advisory board that could discuss research or treatment policies—a move
toward meaningful patient-centricity—was “out of the question”.