Defining Value in Healthcare

There’s a vigorous debate in the country re the cost, and availability, of healthcare. Unfortunately, there’s little discussion of the value of the product patients receive. Mostly, staggering national costs are reported, with cries of pending collapse of the system if allowed to continue. Seldom is a voice raised that questions whether patients are getting value for their money, or even what healthcare value looks like.

There are some initiatives under the Affordable Care Act (ACA), like the Medicare program designed to reduce readmissions to hospitals, but it’s primarily a scorecard, not a measure of value. A surgery patient re-entering a hospital within 30 days of release due to an infected incision, is counted the┬ásame as a patient involved in a vehicle accident two weeks after suffering a heart attack.

So, just what is value as regards healthcare? Is it low premiums, deductibles, and co-pays? What about choice of doctors, clinics, and hospitals? Is it affordable prescription drug costs? Or, is it all these factors, and more? It all depends on who you ask.

A middle class family of four might opt for less choice, and lower-cost coverage, while someone with a serious medical condition would prefer more freedom at choosing doctors, specialists, and medical centers. Seniors on multiple medications may feel that generous prescription drug coverage best suits their needs. Do these differing opinions sound familiar? They should, because in just about every other sector of the US economy, individual consumers demand options, and seek out products and services that best serve their needs. For some reason, healthcare is treated differently, as if choice and individual taste were dangerous.

How might the healthcare system in America be different if patients held the purse strings, not employers or politicians? What if insurance companies were only guaranteed business if they provided a good product at a price acceptable to customers? What if a medical practice that delivered sub-standard care faced financial ruin when their patients took their money elsewhere? What if even the poor had real choice of doctors and hospitals?

I believe that health insurance, and health care, would see dramatic improvements in cost and quality, as companies, doctors, and hospitals scrambled to attract clients. Providers would be free to develop novel methods to make care more effective and less expensive, without having to hurdle the bureaucratic roadblocks lurking in the multi-layered morass of the current system. Most importantly, each individual, and every family, would be free to decide for themselves which companies, and which healthcare providers, best satisfied their needs. Value would no longer be a vague concept, but, would instead, be defined in millions of everyday healthcare transactions by the ultimate consumers, patients.