Much has happened in the last three years within health services: the accelerated impact of the Human Genome Project is but one example. But the most significant changes have taken place outside the service. Chief among them is the increase in citizen and patient interest and influence, through the spread of the smartphone in all countries – rich and poor alike.
The other huge external factor has been the continued economic problems in most countries. Even where investment in healthcare is increasing, it is not rising fast enough to meet need and demand. Healthcare is facing a huge challenge and our focus needs to shift to value – but there are three different types.
1. Allocative value
The first we call ‘allocative value’. Have we allocated resources to different groups equitably and in a way that maximises value for the whole population?
Groups could be defined either by clinical condition, such as cancer, mental health or respiratory disease, or by a characteristic, such as having multiple morbidity and frailty. These groupings can be called programmes.
Once resources have been allocated to programmes, it becomes the responsibility of those who manage services – many of whom are clinicians – to carry out further allocation within the programme budget. So, for example, allocating resources to asthma or chronic obstructive pulmonary disease (COPD), or sleep apnoea, within a respiratory programme budget.
Furthermore, once money has been allocated within the respiratory budget to, for example, COPD, the clinicians and patients need to get together to work out the best value through the right distribution of resources into prevention, diagnosis, treatment, rehabilitation, and long-term support for each system, using the STAR tool.
2. Technical value
Work to improve the quality and safety of healthcare obviously increases the value derived from resources allocated to a particular service. Don Berwick, a renowned international expert on patient safety, gave an impassioned speech about the ethical imperative to tackle waste in healthcare. But this is only one type of value – technical. There are two other types of particular interest.
3. Personalised value
The third is personalised value. We need to ensure that decisions are based on the best current evidence, a careful assessment of an individual’s clinical condition, and an individual’s values. These are the values they place on good and bad outcomes, because even the highest quality healthcare can do harm.
These are the three types of value we need to focus on in the 21st century.
Prof Sir Muir Gray is director of Better Value Healthcare (BVHC). Follow him and the organisation on Twitter: @muirgray @BVHC
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