4
THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS
Executive summary
All medical care should respect individual patient needs, preferences and values. Healthcare systems
around the world, though, are struggling to put in practice this apparently simple proposition.Traditionally, medical care, in general terms, has been arranged around providers and the services they
could give to the patients needing them. Such health systems have, over many years, had substantial
successes in increasing human health and longevity. Nevertheless, in recent decades rising costs mixed
with social and technological changes—which simultaneously decreased the information asymmetry
between clinician and patient, changed the kind of service individuals expect in a host of areas, and
undermined social deference, which re-enforced the traditional status of medical personnel—have
driven the need for a greatly restructured approach to care provision.The result has been the increasing policy emphasis on a shift toward value-based care, which
focuses on the outcomes of treatment rather than the inputs. In defining value, advocates of such
arrangements stress the need to consider not simple clinical outcomes, but those that matter to
patients. The concept of “patient value” in this report goes slightly further—not only do the outcomes
have to be those of importance to patients, the assessment of that importance needs to be done with
and by patients.Health system provision dedicated to improving such value can no longer be organised around
clinicians or budgets, but integrated around patients themselves and taking into account their overall
individual health needs rather than simply focusing on single diseases as they appear. Patient-centred
care takes this even further, with the patient having an active role in everything from care pathway
design to their own treatment decisions.Such healthcare represents a huge transformation, both in terms of culture and organisation, but does
not throw the baby out with the bathwater. Clinicians remain a key part of successful delivery and the
experts in what medicine can achieve. Patient-centred care is better understood as a shift from “doctor
knows best” to “doctor and patient both have important knowledge to bring to the table”.This transition toward patient-centred care designed around maximising patient value has already
begun in many countries, but the degree of change is uneven in different countries and also across the
myriad elements of healthcare systems within those states.To examine the progress of the evolution so far, and draw lessons from it for the future, The Economist
Intelligence Unit has created the Patient-Centred Care Scorecard. This looks at how well health
systems in nine countries—Brazil, China, France, Germany, Italy, Japan, Spain, the UK and the US—
are doing on a range of metrics relevant to achieving comprehensively patient-centred healthcare
provision. Accompanying this effort was a programme of 13 expert interviews, a survey of 45 patient
groups and other stakeholders, consultation with an advisory board made up of leading authorities,
and extensive desk research.