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

8

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

found that most revealed a marked disparity between the wishes of the two.^8 In a battle of aphorisms,

the doctor who knows best seems to be clashing with the customer who is always right.

The rise of value-based healthcare

The preceding description is simplified to make a point about the durability of medical paternalism and

the essential backdrop it provides to current debates. Such attitudes within healthcare, however, are

only one part of a much more complex picture. Nearly every expert interviewed for this study echoed,

to some degree, the words of Eleanor Perfetto, senior vice-president of the US National Health Council:

“Paternalism is still there, but things are changing.” This shift is part of a broader transformation, which

has accelerated over the past decade, in understanding the goals of healthcare and how it should be

delivered.

The transition was not inevitable on purely healthcare grounds. Provider-controlled and focused

systems have, whatever their faults, brought substantial health improvements. Life expectancy has

risen steadily for more than a century and a half across much of the world reflecting, in part, the

progress of health systems against various diseases.^9

However, a series of important social and economic trends—some decades old, some more recent—

have been driving change.

The most prominent of these are:

 the impact on patients of various human rights movements across much of the world;

 increasing expectations by individuals of all their health service providers, driven by the

experience of ever more convenient and technology-enabled consumer marketplaces;

 the shift in the disease load away from acute, communicable conditions to chronic disease

requiring more continuous, integrated care;

 the experience of living with such chronic diseases, through which patients typically develop their

own expertise over years of being affected;

 the greater availability of information related to diseases, potential treatments and the patient

experience, especially with the spread of the internet;

 the ability of improved technology to track and measure a far wider range of health outcomes

than previously; and

 the need to curb the ever-growing cost of healthcare systems frequently underwritten by

governments that are facing resource limitations, with the resultant increased power that payers

are demanding from clinicians over decision-making.

These developments have collectively brought into question the financial sustainability of provider-

focused and -controlled healthcare, while reducing the knowledge asymmetry and social deference

that undergirded the relative power of clinicians within health systems in the past. The old ways of

8. Axel Mühlbacher and Christin Juhnke
   “Patient Preferences Versus Physicians’
   Judgement: Does it Make a Difference in
   Healthcare Decision Making?” Applied
   Health Economic and Health Policy, 2013.


9. Jim Oeppen and James Vaupel, “Broken
   Limits to Life Expectancy,” Science, 2002.