22
THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS
Doctors are most often accused of worrying about status, but they are far from alone. A review of
reports on patient-centred care from 2013 found that: “Managers, physicians and nurses all used the
discourse...to imply that their own group was patient centred while other group(s) were not.” Patient
groups, meanwhile, sometimes downplayed the commitment of others and used the concept of
patient-centricity to advocate other, more controversial goals, such as a greater control over decision-
making than many patients want. Overall, the study found that the idea of patient-centricity “can easily
become a weapon on an intergroup battlefield” where the conflict is an old one over relative influence
within health systems.”^23Another potential challenge is cost.^24 As Mr Graham explains, inevitably any major change requires
outlay. For example, “a robust survey programme or new job roles will all have costs attached, even
while many providers are struggling with funding.” Ms Erb-Herrmann adds that care that takes patient
preferences seriously will come under pressure to spend more in certain areas. “If you talk about
preferences and values,” she says, “customers most often ask about innovative treatments. When you
talk about innovative treatments, you are talking about more expensive ones most of the time.”Cost, however, can be a driver of change rather than barrier if understood properly. As Mr Graham
notes, a shift toward patient-centred care needs to, and can, be seen as “win-win”. He cites as an
example that a greater focus on certain patient-centred metrics, such as faster hospital discharges or
fewer unplanned readmissions, can save health systems money. As noted earlier, one aim of VBHC is
to be cost-saving overall, although success in this area has been slow.Similarly, while patients are certainly likely to be interested in innovative new treatments if they
promise improved results, better informed individuals do not inevitably want more expensive care.
One review of the impact of better information through use of decision aids—tools such as pamphlets,
videos or web-based teaching that brief patients on treatment options, possible side effects and other
relevant considerations—found good statistical evidence that they made patients more knowledgeable
and confident in their choices.In some cases, such as adoption of a new treatment for diabetes and preventative mastectomies for
those with genes associated with breast cancer, use of these aids led to more selecting these newer or
more radical options. Overall, though, the review found that better informed patients, especially when
considering surgery, tended to opt for more conservative therapies. The latter may actually conserve
system resources, although not enough studies had been done on cost-effectiveness to say anything
with certainty.^25A shift to patient-centred, integrated care may require investment, but, as with VBHC as a whole, long-
term costs need not grow and may even decrease.A final barrier is that even those well-disposed to patient-centricity are still feeling their way forward in
a very complex field. “A lot of people and organisations are talking about it, but not fully understanding
it,” says Ms Perfetto. She adds that the transition will be “multifaceted like any other complex
behavioural change and requires making sure that everyone has a common understanding of what it- Sara Kreindler, “The politics of patient-
centred care,” Health Expectations, 2013 - See, for example, Grant Martsolf et al,
“Cost of Transformation among Primary
Care Practices Participating in a Medical
Home Pilot,” Journal of General Internal
Medicine, 2016, which looks at the costs
of changing from a traditional primary
care practice to a patient-centred medical
home in the US. - Dawn Stacey et al, “Decision aids for
people facing health treatment or
screening decisions,” Cochrane Database
of Systematic Reviews, 2017