From the desk of the Chief Medical Officer
By Dave Edwards, MD
What is a cynic? A man who knows the price of everything and the value of nothing. - Oscar Wilde
More and more, we are hearing the term “value” being bantered about in health care. What does value really mean? Conceptually, it has been expressed in mathematical terms such as Value=Quality/Cost. It reflects the recognition that cost must be a consideration and that all incremental increases of quality cannot occur without consideration of the resources consumed.
A recent article in the Annals of Internal Medicine (Owen DK, Quaseem A, Chou R and Shekelle P. High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. Ann Intern Med. 2011;154:174-180) notes, “Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential.” They suggest a two-step approach in evaluating value. First, eliminate care that is harmful or has no benefit and then provide that care where the benefits are commensurate with the costs.
In order to follow these steps, we must understand the benefits, harms and costs. This will allow us to understand whether it has good value. The costs are not limited to just the costs of the interventions, but also include all the downstream costs that may be associated with an intervention. For example, though mammograms detect breast cancer at earlier stages, the downstream costs that also need to be considered include biopsy costs (both for true and false positive studies) and the subsequent treatments for cancer if it is found. They also discuss the use of QALY(quality adjust life years) in accessing the incremental cost effectiveness ratio which allows us to compare the value of different interventions.
Clearly, this professional society understands the need to start educating its members on this new world order soon to have a major impact in health care as well as in its delivery. Some may wish to be cynical and try to ignore this, but they will not be able to be cynical for long.
“Price is what you pay. Value is what you get.” - Warren Buffett