THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSdoing things, whatever the very real benefits they brought, are no longer fit for modern medical,
budgetary or social conditions.
Any replacement, though, needs to provide at least equally effective care, and ideally better. This is
not simply a matter of dethroning clinicians and putting patients in their place, says James Morrow,
a general practitioner (GP) in England’s NHS. In his experience, although many patients living with
chronic conditions “are experts in their diseases and physicians are really there to help them in
managing those conditions, unfettered consumerism in healthcare can lead to numerous undesirable
outcomes, such as misuse of medications, risks of well-intentioned but misguided investigations, and
therapeutic interventions more driven by emotion than evidence. There has to be balance.” At the very
least, the healthcare provider needs to define what is possible.
Moreover, health systems cannot simply set aside their moral and legal responsibilities in the name
of patient choice. Isabella Erb-Herrmann—Bevollmächtigte des Vorstandes (representative of the
management board) at German insurer AOK Hessen—explains that paying for innovative new options
that a well-informed patient might want, but that have not been signed off by the medical authorities,
can lead to liability if something goes wrong. “These are the really tricky questions. Patient value
needs to protect patients.” Dr Morrow adds that “the elephant in the room with patient partnership is
medical negligence and litigation, which constrain and drive doctor behaviour through fear rather than
necessarily doing what patients want.”
Two interrelated concepts are central to the current thinking on how to square this circle. This report
uses their most common labels, “patient value” and “patient-centred care”, although the terminology
is far from fixed.
The debate around value-based healthcare (VBHC), although more recent than both patient value
and patient-centred care, has reshaped the understanding of both. The essence of VBHC is to
move healthcare from a focus on rewarding medical interventions or inputs, such as the number
of appointments or operations, toward one on value. The latter is defined as the outcomes of
interventions divided by their cost. In other words, results matter more than the extent of activity.^10
The hoped-for impact is not only better outcomes but, eventually, a reduction in waste and therefore
costs within the healthcare system. In this way, patients and payers are both further ahead.
Numerous studies of VBHC have shown improved clinical outcomes of different kinds. To date,
evidence for cost benefits has been mixed.^11 This, though, may reflect the variety of value-based
approaches being trialled, start-up costs and time to gain familiarity with new processes. A recent
survey of 120 American payers suggests that economic benefits have finally begun to appear. It found
that, on average, value-based care strategies had reduced medical costs at organisations that had
adopted them by 5.6% in the past year.^12
Whatever the teething problems, VBHC now dominates thinking on healthcare reform. It is a formal
policy goal in places as diverse as the US, the UK, Japan and several Spanish regions, to name a few
jurisdictions.^13
- The first major statement explaining and
advocating VBHC was Michael Porter
and Elizabeth Teisberg, Redefining Health
Care: Creating Value-based Competition
on Results, 2006. - Lawton Burns and Mark Pauly,
“Transformation of the Health Care
Industry: Curb Your Enthusiasm?” Millbank
Quarterly, 2018; David Bailey, “Value-
Based Care Alone Won’t Reduce Health
Spending and Improve Patient Outcomes,”
Harvard Business Review, 2017. - ORC International, Finding the Value in
Value Based Care, 2018. - For an extensive discussion of value-based
care and its state in various countries,
see the Economist Intelligence Unit’s
dedicated web hub.